Out-of-Pocket Maximum
Also called: MOOP, Out-of-Pocket Limit
In plain English
The most you'll pay for covered medical services in a plan year. Once you reach this amount, your insurance pays 100% of covered services for the rest of the year. This includes your deductible, copays, and coinsurance — but NOT your monthly premium.
Real-world example
Your plan has a $6,000 out-of-pocket maximum. By August, between your deductible, copays, and coinsurance, you've paid $6,000. For the rest of the year, insurance pays 100% of covered in-network services.
Why this matters for your bill
Your out-of-pocket maximum is your financial safety net. For 2024, ACA marketplace plans cap this at $9,450 for individuals. If you're facing a major surgery or ongoing treatment, knowing your max helps you plan. Once you hit it, everything covered is free for the rest of the year.
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