Annual Out-of-Pocket Maximum Limits

The Affordable Care Act (ACA) requires health plans of all sizes to comply with an overall annual out-of-pocket (OOP) maximum limit on cost-sharing, effective for plan years beginning on or after January 1, 2014. The annual OOP maximum limit applies only to “essential health benefits” that are provided on an in-network basis and is adjusted annually by the Department of Health and Human Services (HHS) according to the premium adjustment percentage (a factor computed according to rules established by the ACA). The limit applies to plan years commencing in the applicable calendar year.

Download the Annual Out-of-Pocket Maximum Limits Publication