• Languages
  • Contact Us

Out-Of-Pocket Maximum

Out-Of-Pocket Maximum Limit

For plan years beginning on or after January 1, 2016, annual out-of-pocket (OOP) maximums for all plans may be no higher than $6,850 for self coverage and $13,700 for family coverage. These amounts are subject to change every year as determined by the IRS. All benefits contribute to the OOP maximum, including prescription benefits.

Year

OOP Maximum Limit
(Self Only)

OOP Maximum Limit (Family)

2015

$6,600

$13,200

2016*

$6,850

$13,700

*High deductible health plan out-of-pocket maximum limits for 2016 will be $6,550 and $13,100 for self-coverage and family coverage, respectively. 

Note: Grandfathered plans are not required to meet this provision.