What applies to maximum Out-of-Pocket PPO Plans?

An out-of-pocket maximum is a cap, or limit, on the amount of money you have to pay for covered health care services in a plan year. If you meet that limit, your health plan will pay 100% of all covered health care costs for the rest of the plan year. Some health insurance plans call this an out-of-pocket limit. A plan year is the 12 months between the date your coverage is effective and the date your coverage ends.

If you have dependents on your plan, you could have individual out-of-pocket maximums and a family out-of-pocket maximum. This depends on the terms of the plan.

Maximum Out-of-Pocket for individual coverage is $12,000 and $24,000 for family coverage for the 2027 plan year ($10,600 and $21,200 for the 2026 plan year, respectively).