The Affordable Care Act (“ACA”) Maximum Out of Pocket Limits (“MOOP”) Explained
Under the Affordable Care Act (“ACA”), aka Obamacare, limitations on cost sharing apply for plan or policy years that begin in or after 2017. This requirement applies to all non-grandfathered group health plans, including non-grandfathered self-funded and large group health plans. This requirement does not apply to transitional relief and retiree-only plans.
What is the out-of-pocket maximum?
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- It is the most you will have to pay for covered medical services in a year.
- It includes your costs for deductibles, co-payments, and coinsurance.
- It does not include your monthly premiums.
- It does not include costs for services that your plan doesn’t cover or for out-of-network care.
The Annual Maximum Out-of-Pocket Limits (“MOOP”) for ACA Health Plans
Bronze 60 Metallic TIER are as follows:
| Bronze 60 TIER | 2025 | 2026 |
| $8,850 | $9,800 | |
| $17,700 | $19,600 |
The Bronze 60 Metallic TIER, typically has the lowest premiums but the highest deductible and out-of-pocket costs, making it better suited for persons who don’t expect to incur many medical claim expenses and need the lowest-priced health insurance possible.
The Standard Silver 70 Metallic TIER, remains, for many, the more popular TIER, next to the above-noted Bronze 60 TIER.
The other Metallic Silver TIERs are the enhanced Silver 73, 87, 94 (these are only available to those below the Federal Poverty Limits, and are annually reset by the IRS).
The next TIER is Gold 80 (this TIER has no Medical Deductible, along with a lower MOOP).
The next TIER is the Platinum 90 (this TIER has no Medical Deductible, along with the lowest MOOP).
See here a published article by Paul M. League, titled: “Seeing Through the Smoke and Mirrors of Obamacare.
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