Cost-sharing limits-Industry News

Cost-sharing Limits Released by CMS for 2024

The Centers for Medicare and Medicaid Services (CMS) recently released the maximum limits on cost-sharing for 2024, which will go into effect for plan years beginning on or after January 1, 2024. The maximum annual limitation on cost sharing in 2024 is:

  • $9,450 for self-only coverage
  • $18,900 for family coverage

The limits have increased by approximately 3.8% from the 2023 limits.

What is an Out-of-Pocket Maximum?

Out-of-pocket maximum is also commonly referred to as cost-sharing limits. Under the Affordable Care Act (ACA), health plans must comply with annual limits on total enrollee cost-sharing for essential health benefits (EHB). Due to inflation, the CMC adjusts the limits by January of the preceding year, and the limits apply to all non-grandfathered health plans (i.e., self-insured and fully insured).

Deductibles, copayments, coinsurance, and other out-of-pocket expenses count toward the cost-sharing limit. Please note that premiums and noncovered service expenses do not count toward the limit. Similarly, plans with provider networks may not count out-of-network expenses toward the limit.

 

If you have any questions regarding the 2024 cost-sharing limits, please contact your dedicated Creative Benefits, Inc. team member.