Out-of-Pocket Max: $6,000 Cap, Nothing Paid Yet
Starting the plan year fresh with a $6,000 out-of-pocket maximum, your worst-case total exposure is $6,000 in cost-sharing plus $3,000 in premiums.
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.
Understand your full financial exposure for the year with a $6,000 out-of-pocket maximum and $250 monthly premium.
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.