Key Takeaways
- It caps your yearly spending on covered care (premiums are excluded).
- Non-covered services like hearing aids, lenses and dental usually do not count.
- Plans may set both calendar-year and lifetime maximums.
The out-of-pocket maximum is the total amount you can pay for your healthcare in a year, not including your premiums. Once you reach it, your plan covers the rest of your covered costs.
Services that Original Medicare does not cover — such as hearing aids, corrective lenses or dental work — typically do not count toward it. Plans might include both calendar-year and lifetime maximums, so it is wise to know what you could afford in a worst-case year.