U.S. · 2026 plan year
Out-of-pocket maximum calculator.
Enter your deductible, coinsurance, copays and expected charges to see what you pay and when you reach the out-of-pocket maximum.
The 2026 federal out-of-pocket limit is $10,600 for one person and $21,200 for a family. With a $3,000 deductible and 20% coinsurance, $40,000 of covered charges plus $500 of copays costs you the full $10,600; you reach the maximum at about $38,500 of covered charges.
Your numbers
Result
How this is calculated
You pay covered charges up to your deductible. After that you pay your coinsurance percentage of each remaining covered charge. Copays are added on top. Your yearly total is the sum of the three, capped at the plan's out-of-pocket maximum; after you hit it, the plan pays 100% of covered in-network care for the rest of the plan year. The charges at which you reach the maximum are the deductible plus (maximum − copays − deductible) ÷ coinsurance.
HealthCare.gov defines the out-of-pocket maximum as the most you pay for covered services in a plan year and gives the 2026 limits: $10,600 for an individual and $21,200 for a family. Premiums, spending on services your plan does not cover, out-of-network care and charges above the allowed amount a provider may bill do not count toward it. Limits checked on October 26, 2026; your plan's own maximum may be lower.
Worked example
$3,000 deductible, 20% coinsurance, $500 of copays, $40,000 of covered charges. You pay the $3,000 deductible, then 20% of the remaining $37,000, which is $7,400, plus $500 of copays: $10,900. That is more than the $10,600 limit, so your cost stops at $10,600. You reach the maximum at $3,000 + ($10,600 − $500 − $3,000) ÷ 20% = $38,500 of covered charges.
A smaller year, $8,000 of covered charges, no copays. $3,000 + 20% of $5,000 = $4,000, with $6,600 left before the maximum.
Limits of this estimate
It assumes one deductible and one coinsurance rate for all care, ignores prescription tiers, separate deductibles and out-of-network rules, and treats the family maximum as a single pool. Your plan documents control.
Sources
Primary sources opened and checked on October 26, 2026. Figures are as published on that date and are not a prediction of your own terms.
Common mix-ups
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Often assumedMy monthly premiums count toward my out-of-pocket maximum.
What the source saysHealthCare.gov says premiums do not count toward the out-of-pocket limit. Only in-network deductibles, copayments and coinsurance for covered services count. [1]
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Often assumedAn out-of-network bill counts toward the maximum once I hit it, so the plan pays it in full.
What the source saysHealthCare.gov says spending on out-of-network care does not count toward the out-of-pocket limit, and neither do charges above the allowed amount that a provider may bill. [1]
Checked against these sources on .
Frequently asked questions
What is the out-of-pocket maximum for 2026?
HealthCare.gov lists $10,600 for an individual and $21,200 for a family for the 2026 plan year. Your plan can set a lower maximum.
What counts toward the out-of-pocket maximum?
In-network deductibles, copayments and coinsurance for covered services. Monthly premiums, services your plan does not cover, out-of-network care and charges above the allowed amount do not count (HealthCare.gov).
What happens when I hit the maximum?
The plan pays 100% of covered in-network benefits for the rest of the plan year. You still pay premiums and anything the plan does not cover.
Is the deductible part of the out-of-pocket maximum?
Yes. The deductible is the first part of what you pay, and it counts toward the maximum along with coinsurance and copays.
How does coinsurance work?
After you meet the deductible, you pay a percentage of each covered bill and the plan pays the rest, until your total spending reaches the out-of-pocket maximum.
Not financial advice
This page is general information, not financial, legal or tax advice. Your loan, card or plan terms control and may differ from the examples. Confirm anything that matters with your lender, bank, insurer or a qualified adviser before you act. Everything runs in your browser; nothing you enter is sent anywhere.