Human Resources News & Insights

Just released: ACA’s 2018 out-of-pocket maximums

This could be one of the last ACA actions before Obamacare begins to be dismantled by the incoming Trump administration. 

The Department of Health and Human Services (HHS) just released the 2018 out-of-pocket (or “cost-sharing”) limits for non-grandfathered group health plans covered under the ACA.

The limit for self-only coverage will increase $200, and the limit for family coverage will rise $400 over 2017’s limits.

Here are the limits for the most recent years on the books:

  • 2016 — $6,850 for self-only coverage and $13,700 for family coverage.
  • 2017 — $7,150 for self-only coverage and $14,300 for family coverage.
  • 2018 — $7,350 for self-only coverage and $14,700 for family coverage.

The out-of-pocket maximum limit includes:

  • the yearly deductible
  • co-payments, and
  • co-insurance.

Costs excluded from the limit include:

  • premiums
  • billed amounts for out-of-network cost-sharing, and
  • spending for non-essential health benefits.

Grandfathered and retiree-only health plans are excluded from having to comply with these out-of-pocket maximums.

Note: These out-of-pocket maximums are not the same limits applied to HSA-compatible high-deductible health plans (HDHPs), which are typically lower. The limits for HDHPs haven’t yet been released for 2018.

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