ACA—Out of Pocket Maximum Limits

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 out-of-pocket maximum limits for ACA Health Plans are as follows:

Coverage 2016 2017
Individual $6,850 $7,150
Family $13,700 $14,300

Health Savings Accounts are subject to lower annual out of pocket maximum limits. The 2016 limits remain unchanged for 2017.

2016:  $6,550 individual/$13,100 family

2017:  $6,550 individual/$13,100 family