Out-of-pocket maximum.
In plain English
This is the number that defines your worst-case year, and it's the most important number on a plan comparison chart. Deductible, copays, and coinsurance all count toward it. Premiums don't, and out-of-network care often has a separate, higher limit or none at all.
01Why it matters
It's the real cap on a catastrophic year, which is the entire point of having health insurance in the first place.
02The math, step by step
Plan with a $3,000 deductible and $6,500 out-of-pocket max. A $90,000 hospitalization costs you at most $6,500 for covered in-network care, no matter what the bills say. That's what the plan is actually for.
Illustrative example. The amounts here are hypothetical, chosen to show how the math works, not real quoted rates or figures.
03What this is NOT
It is not a cap on premiums, out-of-network charges, or non-covered services. Read the in-network vs. out-of-network rows separately.
Plain-English answers from our glossary. Receipts included. Never advice.
Educational tool. Answers come only from ClearMoneySchool's published glossary and are not advice. Why we never give advice