Out-of-Pocket Maximum Calculator

How it is calculated

Two simple comparisons against your plan's yearly ceiling:

total exposure = min(out-of-pocket max, deductible + coinsurance cap)
remaining = max(0, out-of-pocket max − spent so far)

All four fields are dollar amounts for one plan year. The deductible is what you pay before the plan shares costs; the coinsurance cap is the most you could pay in your share after that; the out-of-pocket maximum is the plan's overall ceiling. Adding the first two shows how much you could owe in theory, but you never pay more than the ceiling, so the smaller of the two is shown. "Spent so far" is optional and counts as $0 when blank. If you have already spent more than the ceiling, the remaining amount shows $0.00. The tool takes your own figures; it does not know which costs count toward your plan's limit, such as premiums or out-of-network bills.

Common mistakes

• Counting premiums as spending. Monthly premiums normally do not count toward an out-of-pocket maximum, so adding them makes the remaining amount look smaller than it is.
• Entering the family limit when only one person's limit applies, or the reverse. Check whether your plan uses an individual or a family maximum.
• Including costs that do not count, such as out-of-network bills or non-covered services, in "spent so far". Only the amounts credited by your plan should go in.
• Entering the deductible as the maximum. The deductible is the lower threshold; the maximum is the higher ceiling on total payments.
• Assuming the plan pays 100% as soon as the deductible is met. Coinsurance usually continues until the out-of-pocket maximum, which is what the "remaining" figure measures.