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Cost-sharing Limits for 2024 Plan Years

cost sharing limits

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The Centers for Medicare and Medicaid Services released the cost sharing limits for 2024 under the Affordable Care Act (ACA). The maximum limit on cost sharing is $9,450 for self-only coverage and $18,900 for family coverage.

The ACA requires health plans to place annual limits on enrollees’ out-of-pocket spending for essential health benefits (EHB). These cost-sharing limits apply to all non-grandfathered health plans, including self-insured health plans and fully insured health plans.

Any out-of-pocket expenses in respect to EHB must count toward the cost-sharing limit. This may include deductibles, copayments, and coinsurance. Premiums and spending for noncovered services are excluded. Plans that use provider networks are not required to count an enrollee’s expenses for out-of-network benefits toward the cost-sharing limit.

Employers should review the plan designs each year to ensure they comply with the ACA’s cost-sharing limits. Download the bulletin for more details.

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National Insurance Services is not a law firm and no opinion, suggestion, or recommendation of the firm or its employees shall constitute legal advice. Readers are advised to consult with their own attorney for a determination of their legal rights, responsibilities and liabilities, including the interpretation of any statute or regulation, or its application to the readers’ business activities.

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Erin Woulfe

Erin Woulfe

Erin Woulfe likes to write about things that matter. Keeping her finger on the pulse of what’s happening in the public sector world, she blogs about the latest legislative news and employee benefit trends that affect our school, city and county clients. She’s been with NIS since 2002. “I love connecting to our clients and providing them with the tools they need in order to administrate their plan,” says Erin. “Whether that be materials to educate their employees on certain benefits, how to effectively communicate change within an organization, or providing tips and how-to’s to help them make their job easier.”