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.The out-of-pocket limit doesn't include:Your monthly premiumsThe 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.Anything you spend for services your plan doesn't coverOut-of-network care and servicesCosts above the allowed amount for a service that a provider may chargeThe 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.For the 2023 plan year: The out-of-pocket limit for a Marketplace plan can’t be more than $9,100 for an individual and $18,200 for a family.Related contentHow to estimate your total costs for health careMarketplace insurance plan categoriesLearn about deductiblesThe 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.Learn about coinsuranceThe percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.Refer to glossary for more details.Learn about copaymentsA fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible.Refer to glossary for more details.