Definition
The most you pay for covered, in-network care in a plan year, counting deductibles, copays, and coinsurance but not premiums. Once you hit it, the plan pays 100% of covered costs for the rest of the year.
Why it matters
The out-of-pocket maximum defines your true worst-case year, which makes it the right number to size an emergency fund against and the honest way to compare plans, ahead of the premium.
Example
A plan has a $2,000 deductible, 20% coinsurance, and a $6,000 out-of-pocket maximum. A $90,000 hospital stay costs the patient $6,000, not $2,000 plus 20% of the rest, because the maximum caps the year.
Put it into practice
Related terms
This definition is educational, not financial, legal, or tax advice. U.S. rules and limits change; verify time-sensitive details with official sources. See our disclaimer.