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return 'medicare'; For the 2022 plan year, this amount is $8,700 for an individual and $17,400 for a family. Key Takeaways An out-of-pocket maximum is the most you'll need to put toward covered health care services during your plan year. While the terms are related, a deductible is the amount of money you have to pay out-of-pocket for covered healthcare services before your health insurance plan begins covering the cost of your care. For 2023, your out-of-pocket maximum can be no more than $9,100 for an individual plan and $18,200 for a family plan before marketplace subsidies. return 'medicare'; (accessed December 30, 2020). Order a 90-day supply of your prescription medicine. } Understanding Copays, Coinsurance and Deductibles - NerdWallet $4,000 is the out-of-pocket maximum on your plan, which means any other covered services . An out-of-pocket maximum is different from a plan's deductible. . 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. However, the combined OOPMs cant exceed the statutory limit. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. The out-of-pocket maximum does not include your monthly premiums. Typically, the out-of-pocket maximum is higher than your deductible amount to account for the collective costs of all types of out-of-pocket expenses such as deductibles, coinsurance, and copayments. However, plan sponsors can choose a lower OOPM amount. Here is how much Tim would pay with his current insurance and out-of-pocket maximum: Without an out-of-pocket maximum Tim would have paid: Without an out-of-pocket maximum, Tim would pay almost double for the same care. However, your annual expenses are capped at $6,000. If you meet that limit, your health plan will pay 100% of all covered health care costs for the rest of the plan year. The offers that appear in this table are from partnerships from which Investopedia receives compensation. The out-of-pocket maximum (OOPM) is the most you will pay out of your own pocket for covered services under your plan during the calendar year. You may submit your information through this form, or call 855-617-1871 to speak directly with licensed enrollers who will provide advice specific to your situation.