US Medical Term · insurance
Out-of-Pocket Maximum
Límite de Gastos de Bolsillo
In 9 languages
| Language | Term |
|---|---|
| English | Out-of-Pocket Maximum |
| Spanish (Español) | Límite de Gastos de Bolsillo |
| Chinese (中文) | 自付上限 |
| Korean (한국어) | 본인부담 최대액 |
| Vietnamese (Tiếng Việt) | Mức chi trả tối đa |
| Filipino (Tagalog) | Pinakamataas na Gastos |
| Portuguese (Português) | Limite de Desembolso |
| Thai (ภาษาไทย) | วงเงินสูงสุดที่ต้องจ่ายเอง |
| Japanese (日本語) | 自己負担上限額 |
What it means
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.
How to say it
Sentences a patient might use with a doctor, nurse, pharmacist, or insurer:
I am close to my out-of-pocket maximum, so my remaining costs should drop soon.
Estoy cerca de mi límite de gastos de bolsillo, por lo que mis costos restantes deberían reducirse pronto.
Does my out-of-pocket maximum reset on January 1 or when my plan year starts?
¿Mi límite de gastos de bolsillo se reinicia el 1 de enero o cuando comienza mi año de plan?
Once I reach my out-of-pocket maximum, insurance should cover 100% of my covered in-network care.
Una vez que alcance mi límite de gastos de bolsillo, el seguro debe cubrir el 100% de mi atención dentro de la red.
Where you'll see it
Related terms
Related guide
→ US Guide: deductibles copays and out of pocket maxSources
Last reviewed: September 2026