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Glossary/Out-of-Pocket Maximum

Out-of-Pocket Maximum

The most you will pay for covered services in a plan year. After you reach this limit, your insurance pays 100% of covered costs for the rest of the year. In 2025, the ACA out-of-pocket maximum for individual plans is $9,200.

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Related terms

  • Allowed Amount
  • Annual Deductible
  • Appeal
  • Billed Amount

Related articles

  • ACA Open Enrollment Guide
  • Deductible vs Copay vs Coinsurance: What Each One Means and How They Work Together
  • How to Read an Explanation of Benefits
  • Open Enrollment Guide: How to Choose the Right Health Plan
  • Out-of-Pocket Maximum Explained: What It Covers and What It Does Not
  • What Happens to Medical Debt After 365 Days
  • What to Do with Your Deductible at Year End
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