The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs covered benefits.

The out-of-pocket limit doesn’t include:

  • Your monthly premiums
  • Anything you spend for services your plan doesn’t cover
  • Out-of-network care and services
  • Costs above the allowed amount for a service that a provider may charge

The out-of-pocket limit for Marketplace plans varies, but can’t go over a set amount each year.

For the 2022 plan year: The out-of-pocket limit for a Marketplace plan can’t be more than $8,700 for an individual and $17,400 for a family.

Call your Total Benefit Solutions health insurance specialists today at (215)355-2121.