Health Insurance Resource Center

The out-of-pocket maximum is the most a patient will pay for healthcare costs before their health insurance or plan pays 100% of
covered essential health services.

This threshold includes deductibles, co-insurance, co-payments, and similar charges, as well as any other expenditure required of an individual for a covered medical expense. This limit does not include premiums or spending on nonessential health benefits.

The maximum out-of-pocket cost restriction for any person or family plan on the Marketplace in 2014 can be no more than $6,350 for an individual plan and $12,700 for a family plan.
For the most part, health insurance plans with out-of-pocket maximums of less than $5,000 are considered low-end. This is because they might not pay for 100% of essential health benefits like hospitalization or emergency treatment in that price range. Such policies also may charge co-insurance on some services, have high deductibles, or require higher co-payments for certain services.

Learn more about the Affordable Care Act by calling me today at 832-850-6873 or message us!

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