Out-of-Pocket Max: $5,000 Cap, $2,500 Paid Halfway Through
With a $5,000 out-of-pocket maximum and $2,500 already paid, you are halfway to your cap with $2,500 in remaining cost-sharing exposure.
How to use this tool
- Enter your plan's annual out-of-pocket maximum for in-network care.
- Enter how much cost-sharing you've already paid this year.
- Enter your monthly premium and the number of premium months remaining.
- Read your remaining exposure and worst-case total to set your emergency fund.
Track your progress toward your $5,000 out-of-pocket maximum after paying $2,500 in medical costs so far this year.
Frequently asked questions
- Do premiums count toward my out-of-pocket maximum?
- No. Premiums are excluded from the out-of-pocket maximum. This calculator adds them separately so your worst-case total reflects the real money you'd spend.
- What counts toward the out-of-pocket maximum?
- Your deductible, coinsurance, and copays for covered in-network care all count. Premiums, out-of-network charges, and non-covered services generally do not.
- Why should I know my worst-case health cost?
- It tells you the emergency fund you need to weather a serious illness or accident. Once you hit the out-of-pocket maximum, the insurer covers 100% of further in-network care.