HHS PROPOSES INCREASED OUT-OF-POCKET MAXIMUMS

February 3, 2016

In December 2015, the Department of Health and Human Services (HHS) proposed out-of-pocket (OOP) maximums for 2017 non-grandfathered health plans.

 

The proposed OOP maximums are as follows:

 

  • Self-only coverage: $7,150 in 2017 (up from $6,850 in 2016)

  • Family coverage: $14,300 in 2017 (up from $13,700 in 2016)

 

The OOP maximum includes an individual’s yearly deductible and any other cost-sharing responsibilities that he or she may incur after the deductible is met (for example, coinsurance or copays). The OOP maximum does not count towards premiums, cost-sharing for out-of-network care, or spending on nonessential health benefits.

 

This increase is based on methodology outlined in the ACA and is tied to increases in group health care plan premiums. The final rule is forthcoming (HHS’ final rule on 2016 OOP maximums was released at the end of February last year).

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