The Affordable Care Act (ACA) requires non-grandfathered plans to comply with an out-of-pocket maximum on essential health benefits (EHB) which limits the total amount a consumer is expected to spend on healthcare. The out-of-pocket maximum is updated annually based on the percent increase in average premiums per person for health insurance coverage.

Under the Department of Health and Human Services’ (HHS) recently issued final rule, the out-of-pocket maximum will increase for 2021:

  • $8,550 for self-only coverage ($400 increase)
  • $17,100 for family coverage ($800 increase)

In addition, High Deductible Health Plans (HDHP) linked to Health Savings Accounts (HSA) are subject to IRS rules for out-of-pocket expenses and other limits. See summary below for the 2021 adjusted annual limits for Health Savings Accounts (HSA) and affiliated High Deductible Health Plans (HDHP).

 

Annual HSA contribution limits

  • $3,600 for an individual with self-only coverage under a HDHP ($50 increase)
  • $7,200 for an individual with family coverage under a HDHP ($100 increase)

 

HDHP limits

Annual deductible no less than:

  • $1,400 for self-only coverage (no change)
  • $2,800 for family coverage (no change)

Annual out-of-pocket expenses (deductibles, co-payments, and other amounts, but not premiums) not more than:

  • $7,000 for self-only coverage ($100 increase)
  • $14,000 for family coverage ($200 increase)

Our bulletin below contains additional information about the new HSA/HDHP limits and action steps to prepare for these changes in 2021.

Read Our Bulletin

If you have questions or need help, please contact one of our benefits consultants.