Question: What is the out-of pocket limits for 2015?
Answer: For 2015, please be aware that there will two different
out-of-pocket limits.
Overall Out-of-Pocket Limits:
There is an overall cost-sharing limitation to all
non-grandfathered group health plans, as provided in HHS Reg.
§ 156.130(a); PPACA; Standards Related to Essential Health Benefits,
Actuarial Value, and Accreditation, 45 CFR Parts 147, 155, and 156, 78 Fed.
Reg. 12834, 12837 (Feb. 25, 2013).
The overall cost-sharing limits for plan years beginning in 2014
are the same as the maximum out-of-pocket expense limits for self-only and
family coverage for HSA-compatible high-deductible health plans (HDHPs) for
taxable years beginning in 2014 , as provided in PPACA, Pub. L. No. 111-148,
§ 1302(c)(1)(A) (2010).
For 2014, these limits are $6,350 for
self-only coverage and $12,700 for family coverage. The limits for 2015 are
$6,600 for self-only coverage and $13,200 for other than self-only coverage, as
provided in PPACA; HHS Notice of Benefit and Payment Parameters for 2015,
45 CFR Parts 144, 147, 153, 155, and 156, 79 Fed. Reg. 13743, 13802 (Mar. 11,
2014).
For a plan year beginning in a calendar year
after 2014, the cost-sharing limit for self-only coverage is the amount for
self-only coverage for plan years beginning in 2014, increased by an index
amount equal to the product of that amount and the "premium adjustment
percentage" for the calendar year. For coverage other than self-only
coverage, the cost sharing limit for a plan year beginning in a calendar year
after 2014 is twice the amount for self-only coverage. The premium
adjustment percentage for a calendar year is the percentage by which the
average per capita premium for health insurance coverage in the United States
for the preceding calendar year (as estimated by HHS by October 1 of the
preceding calendar year) exceeds the average per capita premium for 2013 (as
determined by HHS).
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