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Out-of-Pocket Maximum Calculator

Calculate how much you will pay for healthcare this year. Track your progress toward your out-of-pocket maximum and see when insurance covers 100%.

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How Out-of-Pocket Maximums Work

Your out-of-pocket maximum is the most you will pay for covered in-network services in a plan year. For 2025, the ACA caps this at $9,200 for individuals and $18,400 for families. Once you reach this limit, your insurance pays 100% of covered services for the rest of the year.

What counts toward your OOP max: deductibles, copays, and coinsurance for in-network services. What does NOT count: monthly premiums, out-of-network charges, and services your plan does not cover. This is why staying in-network is critical — out-of-network costs may have a separate (or no) maximum. Track your overall financial health with our Financial Health Score Calculator.

People Also Ask

Does my premium count toward the out-of-pocket max?
No. Premiums are separate from your deductible, copays, and coinsurance. Only cost-sharing for covered services counts toward the maximum.
What happens after I hit my max?
Your insurance covers 100% of in-network covered services for the rest of the plan year. This resets on January 1 (or your plan renewal date).
Is there a strategy to time medical procedures?
Yes. If you are close to your OOP max, scheduling additional procedures in the same plan year means insurance covers them at 100%. Conversely, if you have not met your deductible, waiting until January means a fresh deductible year.