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The Centers for Medicare and Medicaid Services (CMS) recently released the maximum Affordable Care Act (ACA) cost-sharing limits for 2026. The new limits will be $10,150 for self-only coverage and $20,300 for families. This marks a 10.3% increase from 2025.
Out-of-Pocket Maximum
The ACA mandates annual limits on enrollee cost-sharing for essential health benefits (EHBs), known as the out-of-pocket maximum. Once reached, no further cost-sharing is required for the year. EHBs cover a wide range of services, including emergency care, hospitalization, and prescription drugs. These limits apply to most health plans, with adjustments for inflation made annually by CMS. All enrollee out-of-pocket expenses for EHBs count towards this limit, except premiums and noncovered services. Additionally, plans must include an individual out-of-pocket limit that doesn’t exceed the ACA’s maximum for self-only coverage.
Limits for 2025 and 2026
Starting in 2025, the out-of-pocket maximums are $9,200 for individual coverage and $18,400 for families. In 2026, these increase to $10,150 and $20,300. Employers should annually review their plans to stay within ACA cost-sharing limits.
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