November 07, 2024
Key Actions
- Review and confirm that 2026 plan designs comply with the new ACA cost-sharing limits to ensure adherence to regulatory requirements for out-of-pocket maximums.
The Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) released the 2026 annual limits on cost sharing for group health plans under the Affordable Care Act (ACA).
For 2026, the maximum out-of-pocket limit will rise to $10,150 for self-only coverage and $20,300 for family coverage, representing a 10.3% increase over the 2025 limits of $9,200 and $18,400, respectively.
These adjustments reflect broader premium growth and cost inflation in the health care sector, calculated based on the National Health Expenditure Accounts projections. Under the ACA, HHS must adjust these parameters annually, using a "premium adjustment percentage" to reflect the average growth in health insurance premiums over time. For 2026, this adjustment factor was calculated as 1.6002, which represents an increase in employer-sponsored insurance premiums of approximately 60% between 2013 and 2025.
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Resource
Surprise Billing
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