What is Out-of-Pocket Maximum?
Quick answer
The out-of-pocket maximum is the most you'll pay in a policy year for covered services before insurance covers 100%.
The out-of-pocket maximum is the most you'll pay in a policy year for covered services before insurance covers 100%. It usually includes deductibles, copays, and coinsurance, but not premiums.
Examples
- A $9,000 individual out-of-pocket max caps your annual exposure on covered services.
- Family plans typically have a higher combined out-of-pocket max.
- Out-of-network care often doesn't count toward the in-network max.
Why this matters
ReadMyPolicy shows your worst-case annual cost in plain English — the number most plan summaries bury three pages deep.
Read more in our guides
- What does my insurance actually cover? How to find out in 10 minutes
- Insurance policy exclusions: the coverage gaps most people discover too late
- Health insurance deductible vs out-of-pocket maximum: the difference that can cost thousands
Frequently asked questions
What is Out-of-Pocket Maximum?
The out-of-pocket maximum is the most you'll pay in a policy year for covered services before insurance covers 100%. It usually includes deductibles, copays, and coinsurance, but not premiums.
When does Out-of-Pocket Maximum matter?
ReadMyPolicy shows your worst-case annual cost in plain English — the number most plan summaries bury three pages deep.
What's an example of Out-of-Pocket Maximum?
A $9,000 individual out-of-pocket max caps your annual exposure on covered services. Family plans typically have a higher combined out-of-pocket max. Out-of-network care often doesn't count toward the in-network max.
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