Do Plans Offered Through the Health Insurance Marketplace Have Big Out-of-Pocket Costs?

Last updated: March 30, 2016

Not Always

The health insurance plan choices have different of out-of-pocket costs. Out-of-pocket costs include copayments, coinsurance, and deductibles.

However, the Affordable Care Act (ACA) requires that all plans limit your annual out-of-pocket costs for services.

  • They can be no more than roughly $6,600 for individuals and $13,200 for families in 2015.

  • For 2016, the maximum out-of-pocket is $6,850 for individuals and $13,700 for families.

Exceptions:

  • Out-of-network services don’t count toward these limits.

  • There are separate out-of-pocket maximums for stand-alone dental plans.

  • Plans must also cover certain preventive services without cost-sharing.

Also, if your income is below a certain amount, you may be able to buy a plan with lower cost-sharing and lower out-of-pocket costs. This plan would not make you pay a higher premium.

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