The Department of Health and Human Services (HHS) has proposed 2017 health plan out-of-pocket (OOP) maximums of $7,150 for self-only coverage and $14,300 for family (other than self-only) coverage.
The Affordable Care Act (ACA) imposes annual OOP maximums on the amount that an enrollee in a nongrandfathered health plan—including self-insured and large-group health plans—must pay for covered essential health benefits through cost-sharing.
The OOP maximum includes the yearly deductible and any cost-sharing obligations enrollees have after the deductible is met. It does not count premiums, billing amounts for out-of-network cost-sharing or spending for nonessential health benefits, and OOP maximums do not apply to grandfathered or retiree-only plans.
