The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.
Refer to glossary for more details.
copaymentsA fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible.
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coinsuranceThe percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.
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for in-network care and services, your health plan pays 100% of the costs of covered benefits. The out-of-pocket limit doesn't include:The amount you pay for your health insurance every month. In addition to your premium, you usually have to pay other costs for your health care, including a deductible, copayments, and coinsurance. If you have a Marketplace health plan, you may be able to lower your costs with a premium tax credit. Refer to glossary for more details.
The out-of-pocket limit for Marketplace plans varies, but can’t go over a set amount each year.For the 2024 plan year: The out-of-pocket limit for a Marketplace plan can’t be more than $9,450 for an individual and $18,900 for a family.