March 7, 2016

2017 Cost Share Limits in ACA Plans (article)

The Affordable Care Act (ACA) imposes certain cost-share restrictions on essential health benefits provided under non-grandfathered group health plans, including non-grandfathered self-insured and large group health plans. In 2016, the out-of-pocket limit is $6,850 for self-only coverage; $13,700 for other than self-only coverage. On February 29, 2016, the Centers for Medicare and Medicaid Services announced an increase in the maximum annual limits applicable in 2017 to $7,150 for self-only coverage; $14,300 for other than self-only coverage.


As a reminder, for plan years beginning January 1, 2016, an individual cannot be subject to more than the individual statutory out-of-pocket limit on essential health benefits, even if the individual is covered by a family plan.


These cost share restrictions applicable to ACA plans differ from the out-of-pocket limits applicable to high deductible health plans used in conjunction with health savings accounts, which for 2016 are $6,550 for individual coverage; $13,100 for family coverage.  We expect the 2017 limits to be announced by the IRS later this spring.

The information contained in this article is provided as general guidance and may be affected by changes in law or regulation. This article is not intended to replace or substitute for accounting or other professional advice. Please consult a CBIZ professional. This information is provided as-is with no warranties of any kind. CBIZ shall not be liable for any damages whatsoever in connection with its use and assumes no obligation to inform the reader of any changes in laws or other factors that could affect the information contained herein.      

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