Definition
The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copays, and coinsurance, your health plan pays 100% of covered services. The 2026 ACA limit is $9,450 for individuals and $18,900 for families.
Related Terms
- Deductible
The amount you must pay out of pocket for covered healthcare services before you...
- Copay
A fixed amount you pay for a covered healthcare service after you have met your ...
- Coinsurance
Your share of the costs of a covered healthcare service, calculated as a percent...
- Premium
The amount you pay each month for your health insurance coverage, regardless of ...
- Pre-Authorization
A requirement that your health insurer approve a medical service, procedure, or ...
Understanding healthcare terminology helps you communicate more effectively with providers and make informed decisions about your care. Use our procedure cost database to find fair prices for any medical service.