What is the out-of-pocket maximum on an ACA plan?
The out-of-pocket maximum is the most you have to pay for covered in-network services in a plan year — once you hit it, the plan pays 100% of covered essential health benefits for the rest of the year, per HealthCare.gov (2026); the ACA sets an upper limit on this amount each year.
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What the government has said, on the record
Here's how a federal official described it, on the record:
“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 of covered benefits.”
— Centers for Medicare & Medicaid Services (HealthCare.gov), Centers for Medicare & Medicaid Services (U.S. Department of Health & Human Services), HealthCare.gov Glossary, Out-of-pocket Maximum/Limit (source)
Editor's note: Official HealthCare.gov (CMS) definition. Confirm current rules at HealthCare.gov.
Who said this
Centers for Medicare & Medicaid Services (HealthCare.gov) · Centers for Medicare & Medicaid Services (U.S. Department of Health & Human Services)
Also asked as
- ACA out of pocket max
Sources
Last verified: 2026-07-19