What is an out-of-pocket maximum?

InsuranceWarren TeamPublished April 25, 2026

Quick answer

The out-of-pocket maximum (OOP max) is the most you'll pay for covered, in-network medical care in a plan year. Once hit, your insurance pays 100% of covered services until the plan year resets. ACA caps it at $9,200 single / $18,400 family for 2025.

Out-of-pocket max ceiling concept.

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