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Cost Sharing Limits for Affordable Care Act Plans Increase

October 29, 2024
Julie Kozminski

The Centers for Medicare & Medicaid Services (CMS) on Oct. 8 announced that the maximum annual cost sharing limitation for Affordable Care Act (ACA) plans will increase by 10 percent in 2026.

The maximum cost sharing for enrollees with household income greater than 150 percent and less than or equal to 200 percent of the federal poverty level (FPL) will be $3,350 for self-only coverage and $6,700 for families.

For enrollees earning greater than 200 and less than or equal to 250 percent of the FPL, the maximum cost sharing will be $8,100 for individuals and $16,200 for families.

CMS also announced the maximum premium contribution for someone to be exempt from the ACA’s individual mandate in 2026 will be 7.7 percent of monthly income, a 0.42 percentage point increase from 2025. Although the mandate is no longer in effect, the calculation is still used to determine eligibility for catastrophic coverage.

Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.

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