An expert warned many households knew monthly premiums but overlooked maximum out-of-pocket costs, the yearly cap for covered in-network care after premiums.
That cap included deductibles, copays, and coinsurance. After reaching it, insurance paid the rest for covered in-network care during that calendar year.
For employer or marketplace plans in 2026, the maximum allowable individual MOOP was $10.6K and family coverage reached $21.2K, though some employer plans ran lower.
For Medicare Advantage in 2026, in-network MOOP could reach $9.25K. Original Medicare had no cap on the 20% owed for Part B expenses.
The expert urged households to hold emergency savings covering their full MOOP for two consecutive years, since treatment crossing into January could reset costs.
