What types of payments count toward the annual Out-of-Pocket Maximum?

Deductibles, copayments, and coinsurance contributions.

The annual Out-of-Pocket Maximum represents the absolute ceiling on how much an individual or family must pay out-of-pocket for covered essential health benefits within a single plan year. Crucially, this maximum includes all contributions the policyholder makes toward cost-sharing obligations. This encompasses the full deductible amount paid throughout the year, every fixed copayment made for doctor visits or prescriptions, and every coinsurance percentage paid after the deductible was met. Once this total liability ceiling is reached, the insurance plan assumes 100% responsibility for covering the costs of all subsequent covered essential health benefits for the remainder of that plan year. This maximum is a critical figure for understanding worst-case financial exposure beyond just the recurring premium.