Health · Chapter 15 · Cost Sharing
Stop-Loss / Out-of-Pocket Maximum
Definition
The most an insured pays for covered services in a plan year — deductible + coinsurance + copays. Hit it and the insurer pays 100% for the rest of the year. Does NOT count: premiums, charges above UCR, non-covered services. (ACA cap for 2026: $10,600 individual / $21,200 family — indexed yearly.)
In plain English
The circuit breaker on your medical bills.
Easy to confuse with
These are what this term gets tested against — if you can't tell them apart cold, drill the contrast.
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