Out-of-pocket Limit in the United States

Concept of Out-of-pocket Limit in Health Insurance Law

In this context, the following is a definition of Out-of-pocket Limit: An annual limitation on all cost-sharing for which patients are responsible under a health insurance plan. This limit does not apply to premiums, balance-billed charges from out of network health care providers or services that are not covered by the plan. PPACA requires out-of-pocket limits of $5,950 per individual and $11,900 per family, beginning in 2014. These amounts will be adjusted annually to account for the growth of health insurance premiums.