What is an Out-of-pocket maximum?
An out-of-pocket maximum is the annual dollar cap on what an enrolled individual pays in cost-sharing before a health plan covers 100% of covered services. The IRS uses this figure to determine whether a plan qualifies as a high-deductible health plan eligible for Health savings account contributions. For 2026, IRS-confirmed HDHP out-of-pocket maximums are $8,500 for self-only coverage and $17,000 for family coverage under Rev. Proc. 2025-19. Under the One Big Beautiful Bill Act, bronze and catastrophic marketplace plans qualifying as HDHPs starting January 2026 must also satisfy these annual out-of-pocket thresholds for enrollees to remain eligible to contribute to an HSA.
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