The U.S. Department of Health and Human Services (HHS) published a final rule for new standards for the Affordable Care Act’s (ACA) Marketplaces. The rule updates the methodology for calculating the cost sharing maximum annual limitation. The updated maximum annual limitation is $10,600 for self-only coverage, and $21,200 for family coverage. This is approximately a 15.2% increase from the 2025 limits.
The HHS previous released the 2026 cost sharing limits based on now-outdated methodology. The old limits ($10,150 for self-only coverage and $20,300 for family coverage) have been updated with the revised limits.
Out-of-Pocket Maximum
The ACA caps annual out-of-pocket costs for essential health benefits. Once the maximum is reached, no further cost sharing applies. These limits cover deductibles, copays, and coinsurance, but not premiums or out-of-network costs. Each enrollee also has an individual cap.
Annual Limits
ACA out-of-pocket limits are $9,200 (self-only) and $18,400 (family) for 2025, rising to $10,600 and $21,200 in 2026. Employers should review their plan annually for compliance. Download the bulletin for more details.
