insurance
Out-of-Pocket Maximum
自己負担上限額 (jiko futankin jōgen-gaku)
The out-of-pocket maximum is the most you will have to pay for covered in-network services in a plan year. Once you reach this limit — through deductibles, copays, and coinsurance combined — your insurance covers 100% of covered services for the rest of the year. ACA-compliant plans set federal limits on out-of-pocket maximums annually. Premiums, out-of-network costs, and services not covered by the plan do not count toward this limit.
The out-of-pocket maximum is a key consumer protection under the Affordable Care Act, capping financial exposure for covered services.
In 9 languages
| Language | Term |
|---|---|
| English | Out-of-Pocket Maximum |
| Japanese (日本語) | 自己負担上限額 |
| Chinese (中文) | 自付上限 |
| Korean (한국어) | 본인부담 최대액 |
| Portuguese | Limite de Desembolso |
| Spanish | Límite de Gastos de Bolsillo |
| Filipino | Pinakamataas na Gastos |
| Thai | วงเงินสูงสุดที่ต้องจ่ายเอง |
| Vietnamese | Mức chi trả tối đa |
| Romanization | jiko futankin jōgen-gaku |
Learn more in the guide:
Browse US healthcare guides →Last reviewed: September 2026