Out-of-Pocket Maximum Calculator

About this calculator

The out-of-pocket maximum is the most a health plan enrollee has to pay in a plan year for covered deductibles, copayments, and coinsurance combined, before the insurer begins paying 100% of covered costs for the rest of the year — a protection mandated for most plans under the US Affordable Care Act. It differs from the deductible, which is only the threshold before insurance starts sharing costs at all; the out-of-pocket maximum is the higher ceiling that caps total exposure even after coinsurance kicks in.

Patients and HR benefits teams track out-of-pocket maximum spending to understand worst-case annual healthcare costs when choosing between health plans during open enrollment, and to know when remaining medical bills for the year will be fully covered — an important consideration for anyone facing a major procedure or chronic condition with ongoing costs.

This calculator takes what you've already spent toward your out-of-pocket maximum and your plan's limit to show your total exposure and how much room remains before your plan covers 100% of costs for the rest of the year.