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What does Out-Of-Pocket Maximum mean?

The annual cap on your cost sharing for covered in-network care; premiums and excluded or out-of-network charges generally do not count.

Illustration — not a plan price

After counted in-network cost sharing reaches the plan's maximum, the plan generally pays for additional covered in-network benefits for the rest of the plan year.

The actual plan document controls. Verify its definitions, network, exclusions, dates, and amounts before relying on the illustration.

Definitions here are never for sale — no plan is recommended on a comprehension page.

Source: HealthCare.gov — Glossary · Verified 2026-08-11 · Reviewed by the MedicalRecords.com editorial team · Last reviewed August 11, 2026

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