Out-of-pocket maximum

Your out-of-pocket maximum is a limit on the total amount you pay for healthcare in a given year. Once you have spent this amount on all coverage, including deductible, copayments and coinsurance but excluding your monthly premium, your health insurer will pay 100% of your remaining healthcare costs for the coverage year. For plans purchased through Healthcare.gov exchanges in 2019, the out-of-pocket maximum must be lower than $7,900 for an individual plan or $15,800 for a family plan, but could be lower based on the coverage you choose.