The out-of-pocket maximum is the most an individual or family will have to pay for covered healthcare services in a given year before the health insurance company starts to pay 100% of the costs.

Prescription drug costs are typically not included in the out-of-pocket maximum. Instead, they are subject to a separate deductible and coinsurance.

The out-of-pocket maximum is designed to protect individuals and families from having to pay large amounts of money for healthcare services in a given year.

The out-of-pocket maximum is calculated by adding the deductible, coinsurance, and copayment amounts for all covered healthcare services in a given year.

Once an individual or family reaches their out-of-pocket maximum, the health insurance company will pay 100% of the costs of covered healthcare services for the rest of the year.

The type of health insurance plan, the level of coverage, and the deductible can all affect the out-of-pocket maximum.

According to the Kaiser Family Foundation, the average out-of-pocket maximum for an individual health insurance plan in the United States is $8,000.

According to the Kaiser Family Foundation, the average out-of-pocket maximum for a family health insurance plan in the United States is $16,000.

Under the ACA, the maximum out-of-pocket maximum that an individual or family can be required to pay for covered healthcare services is $10,000.

Individuals and families can reduce their out-of-pocket maximum by choosing a health insurance plan with a lower deductible, a lower coinsurance percentage, and a lower copayment amount.

The deductible is the amount an individual or family must pay before the health insurance company starts to pay for covered healthcare services. The out-of-pocket maximum is the amount an individual or family must pay before the health insurance company starts to pay 100% of the costs of covered healthcare services. The deductible is typically lower than the out-of-pocket maximum.

Coinsurance is a percentage of the cost of covered healthcare services that an individual or family is responsible for paying. The out-of-pocket maximum is the amount an individual or family must pay before the health insurance company starts to pay 100% of the costs of covered healthcare services. Coinsurance is typically a fixed amount, while the out-of-pocket maximum can vary depending on the type of health insurance plan.

A copayment is a fixed amount that an individual or family must pay for a specific covered healthcare service. The out-of-pocket maximum is the amount an individual or family must pay before the health insurance company starts to pay 100% of the costs of covered healthcare services. Copayments are typically lower than the out-of-pocket maximum.

Having a health insurance plan with a low out-of-pocket maximum can provide several advantages, including lower monthly premiums, more predictable healthcare costs, and greater peace of mind.