What's an out-of-pocket maximum?

A: The ceiling on what you pay in a year. Every copay, coinsurance payment, and deductible → dollar for in-network covered care accumulates — and once the total hits your plan's out-of-pocket max, the plan pays 100% of covered in-network care for the rest of the plan year. Therapy included. This is the number that makes a hard year cheaper as it goes: hit the ceiling in July (a hospitalization will do it in a week), and weekly therapy from August to December costs $0. What doesn't count: premiums, out-of-network care on most plans, and anything not covered. Family plans have both per-person and whole-family ceilings.

Worked example: plan with $3,500 OOP max; a rough spring — ER visit, imaging, weekly therapy copays — totals $3,500 by June → therapy, psychiatry, and everything else in-network is free through December. This is precisely the year to increase session frequency, not pause.

Do this: one call to member services: "What's my out-of-pocket maximum, and how much have I accumulated this year?" If you're close and it's fall, do the math before deferring care to January — the meter resets with the plan year. Full insurance-decoder set: deductible → · copay vs coinsurance → · allowed amount →.

Source: HealthCare.gov glossary, out-of-pocket maximum — healthcare.gov.