Out-of-Pocket Maximum Amounts Announced for 2026
The Department of Health and Human Services (HHS) recently announced the 2026 Benefit Parameters, outlining the maximum out-of-pocket (OOP) limits applicable to non-grandfathered plans for plan years beginning in 2026. Each year, these OOP maximums are adjusted for inflation. In 2023, HHS pledged to release the updated amounts “by January of the year preceding the applicable benefit year” and they have indeed stuck to that promise.
Under the Affordable Care Act (ACA), non-grandfathered health plans are required to comply with an overall annual limit on out-of-pocket expenses for essential health benefits, regardless of whether the plan is self-funded or fully insured. The current limits applicable to 2025 plan years are $9,200 for self-only coverage and $18,400 for family coverage. The 2026 limits will be increased to $10,150 for self-only coverage and $20,300 for family coverage, respectively.
June 26, 2025 UPDATE: HHS recently updated the 2026 out-of-pocket expense limitations, changing them to $10,600 for self-only coverage and $21,200 for family coverage. These revised limitations will supersede the previously announced limits of $10,150 and $20,300 for self-only and family coverage, respectively.
Here's a summary of the amounts for traditional plans for the 2025 / 2026 plan years for reference:
OOPMAXes - Annual Out of Pocket Maximums
|
|
Traditional Plans |
HDHP / HSA Plans |
||
|
|
Single |
Family |
Single |
Family |
|
2026 |
$10,600 |
$21,200 |
$8,500 |
$17,000 |
|
2025 |
$9,200 |
$18,400 |
$8,300 |
$16,600 |
High-deductible health plans (HDHPs) with Health Savings Accounts (HSAs) feature different limits than traditional plans, including OOP maxes, along with deductible and contribution limits. Historically these limits are released in May of each year. For reference, the 2025 HDHP/HSA limits were not released by the IRS until May 9, 2024.
Although, it should be noted that if your plans offer both traditional and HDHP/HSA plans (that are not grandfathered), your plans are subject to both sets of requirements and you must ensure compliance with the lowest applicable out-of-pocket maximum. Plus, the ACA requires that a per person (individualized/embedded) out-of-pocket maximum doesn't exceed the ACA limit, even if you are in the larger (family) tier. This assists single family members in accessing benefits sooner without having to hit the full amount for the family tier.
For additional information, please see: IRS Announces HSA and HDHP Limits for 2026
Featured News & Insights
It is a growing reality across the workforce -- employees balancing care for young children and aging parents, often at the same time. Known as the sandwich generation, these employees are under...
Swiftly signed into law on July 4, 2025 by President Trump, the “One Big Beautiful Bill Act” (OBBB) contains a number of provisions which directly impact employee benefits as well as numerous tax and...
National 401(k) Day is a timely opportunity to remind your employees that they play a significant role in their own financial future. Whether they're just starting their career or nearing retirement,...