- On October 22, 2024
The Biden Administration released the health insurance out-of-pocket maximum cost-sharing limits for 2026. These limits will apply to all group and individual non-grandfathered private health insurance plans that are not qualified High-Deductible Health Plans and are sold between January 1, 2026, and December 31, 2026. The limits apply to all of an individual’s cost-sharing other than their premium payments, including plan deductibles, co-payments, and co-insurance. For self-only coverage, the most an individual will need to pay in cost-sharing in 2026 will be $10,150. The aggregate out-of-pocket limit for all other coverage will be $23,300. The new limits will be approximately 10.3 percent higher than the 2025 maximum out-of-pocket cost thresholds of $9,200 for self-only coverage and $18,400 for other than self-only coverage.
If a person buys exchange-based individual coverage, it qualifies for income-based cost-sharing reductions, which also apply to out-of-pocket maximums. The 2026 reduced maximum annual limitation on cost sharing will be $3,350 for enrollees with household income greater than or equal to 100 percent of the federal poverty level (FPL) and $8,100 for enrollees with household income greater than 200 and less than or equal to 250 percent FPL. However, these limits only apply to specific exchange-based individual coverage.
Annual maximum out-of-pocket cost limits are always less for qualified high-deductible health plans that may be paired with a health savings account. The Internal Revenue Service will release the specific limits for those plans later this year.