FAQs ACA Implementation Part 40: Limitations on Cost Sharing

Document Excerpt

Public Health Service (PHS) Act section 2707(b), as added by PPACA, provides that all nongrandfathered group health plans, including non-grandfathered self-insured and insured small
and large group market health plans, shall ensure that any annual cost sharing imposed under the plan does not exceed the limitations provided for under section 1302(c)(1) of PPACA.

Under section 1302(c)(1), an enrolleeā€™s cost sharing for essential health benefits is limited. For plan or policy years beginning in 2019, the maximum annual limitation on cost sharing is $7,900 for self-only coverage and $15,800 for other than self-only coverage. For plan or policy years beginning in 2020, the maximum annual limitation on cost sharing is $8,150 for self-only
coverage and $16,300 for other than self-only coverage.

Link
https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/FAQs-Part-40.pdf

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