Affordable Care Act

Out-of-Pocket Costs for Health Insurance

Updated on February 12, 2020


Out-of-pocket costs are costs for health care that aren’t reimbursed by insurance companies. Generally, out-of-pocket costs include copays, deductibles, and coinsurance for covered services, as well as expenses for services that aren’t covered by insurance companies.

Maximum out-of-pocket costs

It’s also important for you to know that there is an annual limitation on all cost-sharing for which patients are responsible under a health insurance plan. This out-of-pocket limit (or out-of-pocket maximum) does not apply to premiums, balance-billed charges from out-of-network health-care providers, or services that are not covered by the plan.
A Marketplace plan in 2017 had an out-of-pocket-limit of $7,150 for individuals, and $14,300 for a family plan.

How out-of-pocket costs relate to copays, deductibles, and coinsurance

How Insurance Out-of-Pocket works

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