what is out of pocket in health insurance

Out-of-pocket costs in health insurance refer to the expenses for medical care that are not reimbursed by insurance. These costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that are not covered. The out-of-pocket maximum or limit is the most that you will have to pay for covered medical services in a given year. This includes your deductible, copayments, and coinsurance. Once your out-of-pocket expenses reach this limit, your insurance plan takes over and covers 100% of eligible medical costs for the remainder of the year. The out-of-pocket limit does not include monthly premiums, anything you spend for services your plan does not cover, out-of-network care and services, or costs above the allowed amount for a service that a provider may charge. The Affordable Care Act has set a limit on out-of-pocket costs, which for 2023 is $9,100 for an individual and $18,200 for a family.