ACA Out-of-Pocket Maximum is $9100 per person and $18,200 per family in 2023. Except as otherwise specified, unreimbursed in-network covered services that are medical or prescription drug expenses (except for chiropractic services, refractive eye surgery, and all services that are covered under the SHARP DVH Option other than under age 19 pediatric preventive dental, pediatric annual eye examination, and pediatric eyeglasses) are applied to the ACA out-of-pocket maximum includes any co-payments, co-insurances, and deductibles, but does not include the member share contribution costs. Amounts in excess of usual, reasonable, and customary do not apply to the ACA out-of-pocket maximum.
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