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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.

Download our "Guide to Insurance Committees for Public Sector Organizations"

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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Emily Halter-Kinter

Emily Halter-Kinter

Emily Halter-Kinter looks for ways, either large or small, to make a difference each day. She’s outgoing and really loves what she does. Emily enjoys working closely with her clients to provide the best care. As Account Manager for National Insurance Services, Emily works with schools, cities, and counties in Wisconsin on their health insurance, wellness plans, benefit communication, and retirement incentives. She oversees new client implementation, takes policy-related questions, and meets directly with clients to explain their benefits. Emily is a licensed insurance agent and has over 20 years of insurance experience.