PlanWise

2026 Out-of-Pocket Maximum Estimator

Your out-of-pocket maximum is the most you will pay for covered, in-network care in a year — after that, the plan pays 100%. For 2026 a qualifying HDHP's out-of-pocket maximum cannot exceed $8,500 for self-only coverage or $17,000 for family coverage (IRS Rev. Proc. 2025-19); many plans set a lower cap. This estimator models a high-cost year: you pay the full deductible, then your coinsurance share, up to your plan's cap. It is an estimate, not insurance advice — premiums and out-of-network care are excluded.

Source: IRS Rev. Proc. 2025-19 (2026 HDHP limits). Data as of 2026-06-14.

2026 federal HDHP OOP cap (limit):

Estimated you pay this year:

Worst case (your OOP max):

Estimate only — not insurance advice. Model: you pay 100% up to the deductible, then your coinsurance share, capped at your plan's out-of-pocket maximum. The 2026 federal HDHP OOP maximum is $8,500 self-only / $17,000 family (IRS Rev. Proc. 2025-19); your plan's cap may be lower. Premiums and out-of-network care are excluded.

How it works

Enter your coverage type, deductible, coinsurance rate, your plan's out-of-pocket maximum, and your expected total bills. The tool charges you 100% up to the deductible, then your coinsurance percentage on the rest, and caps the total at your plan's out-of-pocket maximum (which itself cannot exceed the 2026 federal HDHP limit). The worst-case figure equals your plan's cap.

Important: This tool is a general estimate for educational purposes only and is not medical, tax, insurance, or financial advice. Figures use the published 2026 limits but your situation may differ. Verify with the primary source and a qualified professional. See our full disclaimer and methodology.

Frequently asked questions

What is the 2026 HDHP out-of-pocket maximum?

For 2026 a qualifying HDHP's out-of-pocket maximum is capped at $8,500 for self-only coverage and $17,000 for family coverage (IRS Rev. Proc. 2025-19). Your specific plan may set a lower cap.

What counts toward the out-of-pocket maximum?

Generally your deductible, copays and coinsurance for covered, in-network care count toward the cap. Monthly premiums and out-of-network or non-covered services usually do not.

Is the ACA out-of-pocket limit the same as the HDHP limit?

No. The ACA marketplace out-of-pocket limit and the HDHP/HSA limit are set by different rules and differ in amount. This estimator uses the 2026 HDHP figures from IRS Rev. Proc. 2025-19.

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Last updated: 2026-06-14