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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.