Most people know what their health insurance premium costs every month. According to Suze Orman, that’s the easy part. The number that can blindside a household is the one hiding in the fine print.
Read More: Suze Orman Reveals the No. 1 Bill You Should Pay First Each Month
Learn More: 7 Low-Risk Accounts Financially Savvy People Trust for Reliable Returns – And How You Can Use Them
In a recent LinkedIn article, the bestselling personal finance author and host of the “Women & Money” podcast zeroed in on a detail she said too many people fail to plan for: their maximum out-of-pocket cost, or MOOP.
Also see the 10 simplest ways to slash healthcare costs in 2026.
Your MOOP is the most you’ll pay out of pocket in a given year for covered in-network care, after premiums. Deductibles, copays and coinsurance all count toward it. Once you hit it, your insurance covers the rest for that calendar year.
The problem, Orman said, is that most people have no idea what their number actually is and haven’t set aside the cash to cover it if a bad year hits.
Check Out: I’m a Financial Planner: Cut These 7 Hidden Expenses To Save Hundreds a Month
The limits vary depending on what kind of coverage you have.
For people with employer-sponsored or ACA marketplace plans, the maximum allowable MOOP for an individual in 2026 is $10,600, or $21,200 for family coverage. Many employer plans set their own lower limits around $4,500 for an individual, but Orman said you need to check your specific plan rather than assume. For family plans, it also matters whether the MOOP applies per person or to the family as a whole.
For Medicare Advantage enrollees, the MOOP can run as high as $9,250 for in-network care in 2026. Even if your plan caps it at half that amount, you could still be looking at more than $4,000 in a single year.
For those on Original Medicare, Orman repeated her standing advice: A Medigap supplemental policy is not optional. Original Medicare covers 80% of Part B expenses with no cap on what you owe for the remaining 20%. Without a Medigap policy, a serious illness or injury can leave you with an open-ended bill.
Orman’s guidance goes beyond just knowing your MOOP number. She said households should have enough in emergency savings to cover that maximum for at least two consecutive years, and her reasoning is practical.
Medical events don’t follow a calendar, she explained. An injury late in the year can push you to your annual limit, and then care that continues into January starts the clock over again for a brand-new year. Two bad years back to back can mean hitting your MOOP twice.
Leave a comment