ACA—Out of Pocket Maximum Limits (“MOOP”)

Under the Affordable Care Act (“ACA”), 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.

The MOOP limits for ACA Health Plans are as follows (Example: Standard Silver 70 Metallic TIER, which is the most purchased TIER thru 2019):

Coverage 2019 2020
Individual $7,550 $7,800
Family $15,100 $15,600

Health Savings Accounts are subject to lower annual out of pocket maximum limits as noted below.

Coverage 2019 2020
Individual $3,500 $3,550
Family $7,000 $7,100