What is an out-of-pocket limit?

An out-of-pocket limit is a limit on the amount of money a person covered by health insurance must pay each year for health care services. This includes money spent on copayments, coinsurance, and deductibles. In Texas, health insurance companies are required to set an out-of-pocket limit for all plans they offer. This limit is the maximum amount a person with health insurance must pay out-of-pocket each year for covered services. This helps to ensure that health care costs are manageable for people with health insurance. The out-of-pocket limit for 2020 in Texas is $8,150 for an individual plan and $16,300 for a family plan. This limit applies to all plans, even those sold on the health insurance marketplace. Knowing the out-of-pocket limit can help people budget for their health care costs and ensure that they can get the care they need.

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