2024 ACA Out-of-Pocket Maximums
Published: 12.22.2022 / Updated: 01.31.2024
The Department of Health and Human Services has announced the new ACA out-of-pocket limits that will apply to group and individual health plans during the 2024 plan year.
To comply with the ACA, non-grandfathered health plans cannot require a participant to pay more out-of-pocket during the plan year than the amounts listed below.The limits apply to cost-sharing items like copayments, deductibles, and coinsurance expenditures. Premiums and spending for non-covered services do not count towards the out-of-pocket limits.
The 2024 ACA out-of-pocket maximum limits are listed below in comparison to the 2023 limits. The ACA OOP maximums represents a 3.9% increase from the OOP maximums for the 2023 plan year.
| ACA Out-of-Pocket Maximums | ||
| Coverage Type | 2023 | 2024 |
| Self-Only Coverage | $9,100 | $9,450 |
| Family Coverage | $18,200 | $18,900 |
Under the ACA, the OOP limitation requirement directly applies to essential health benefits. As a reminder, essential health benefits as defined by the ACA fall within ten categories: (1) ambulatory patient services, (2) emergency services, (3) hospitalization, (4) pregnancy, maternity, and newborn care, (5) mental health and substance use disorder services, (6) prescription drugs, (7) rehabilitative and habilitative services and devices, (8) laboratory services, (9) preventive and wellness services, including chronic disease management, and (10) pediatric services, including oral and vision care.
2024 Limits Announced for HSAs, High Deductible Health Plans, and Excepted Benefit HRAs
Additionally, the Internal Revenue Service (IRS) released updates to the maximum annual 2024 contribution limits for health savings accounts (HSAs) under high deductible health plans (HDHPs). These limits, which have increased slightly from 2023, apply to both individual and family coverage. The updates also include deductible minimums and out-of-pocket (OOP) expense limits for HDHPs and an increase to the maximum amount that may be made newly available for excepted benefit health reimbursement arrangements (HRAs).
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