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Tuesday, 15 March 2016 12:00

Limits on OOP Maximums for 2017 announced

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Limits on health plan out-of-pocket (OOP) maximums for 2017 have been announced by the Department of Health and Human Services.  Annual limits on OOP maximums are imposed by the Affordable Care Act (ACA) as the maximum amount an enrollee in a non-grandfathered health plan could be expected to pay for covered essential health benefits through cost-sharing (carriers can choose to establish lower limits for certain plans).  

The limits apply to both self-insured as well as large-group health plans.  The OOP maximum includes the yearly deductible and any cost-sharing obligations enrollees have, such as coinsurance, once the deductible is met.  The OOP maximum does not include premiums, billing amounts for out-of-network cost-sharing or spending for nonessential health benefits.  The limits below on OOP Maximums also do not apply to grandfathered or retiree-only plans.

Limits on health plan out-of-pocket (OOP) maximums for 2017 have been announced by the Department of Health and Human Services.  Annual limits on OOP maximums are imposed by the Affordable Care Act (ACA) as the maximum amount an enrollee in a non-grandfathered health plan could be expected to pay for covered essential health benefits through cost-sharing (carriers can choose to establish lower limits for certain plans).  

The limits apply to both self-insured as well as large-group health plans.  The OOP maximum includes the yearly deductible and any cost-sharing obligations enrollees have, such as coinsurance, once the deductible is met.  The OOP maximum does not include premiums, billing amounts for out-of-network cost-sharing or spending for nonessential health benefits.  The limits below on OOP Maximums also do not apply to grandfathered or retiree-only plans.

Please note that the limits OOP Maximums for High Deductible Health Plans (HDHP) plans are different.  The limit on OOP Maximums in 2016 for HDHP plans compatible with a Health Savings Account was $6,550 for single coverage and $13,100 for family coverage.

Limits on Out-of-Pocket Maximums for non-HDHP Plans

 

2015

2016

2017

Self-only coverage

$6,600

$6,850

$7,150

Family coverage

$13,200

$13,700

$14,300

Source:  Department of Health and Human Services

Read 19250 times Last modified on Monday, 14 September 2020 19:55
Susan Shepard

Susan is our Operations Manager, directing many of our administrative functions and enabling our client management team to spend more time directly with their customers. Susan received a Bachelor of Science degree in Industrial Design from Arizona State University. Susan joined Fall River in 2015.

She is a native of Pennsylvania, but has lived in Texas, Germany, Arizona and California. An avid crafter, Susan loves scrapbooking, card making, knitting and crocheting, bicycling, golfing and reading, in addition to spending time with her husband and three grown children.