Annual Limitation on Cost Sharing to Increase for 2017

David M. Pixley

Under the ACA, non-grandfathered group health plans must limit enrollees’ out-of-pocket costs for essential health benefits. Under the final HHS Notice of Benefit and Payment Parameters for 2017, the HHS bumped up the out-of-pocket maximums. HHS based its calculations on two factors, the cost sharing limit for 2014, which was $6,350 for individual coverage, multiplied by the premium adjustment percentage for 2017. On average, for the period from 2014 to 2017, the premiums adjustment percentage increased at a rate of 4.3% annually, totaling 13.3%. HHS then rounded down to the nearest $50.

For 2017, the out-of-pocket maximum is $7,150 for individual coverage, up from $6,850 for 2016 and for family coverage is $14,300, up from $13,700 for 2016.