The Department of Health and Human Services (HHS) sets the maximum limit on out-of-pocket expenses for nongrandfathered, non-high-deductible health plans. For 2016, those limits are $6,850 for self-only coverage ($6,600 in 2015) and $13,700 for other than self-only coverage ($13,200 in 2015).
Heads up: The IRS’ inflation adjustments to the limits for health savings accounts and high- deductible health plans should be released shortly.
NEW RULE: Beginning with the 2016 plan year, all health plans must include a provision that requires that the self-only annual limitation on out-of-pocket expenses applies separately to each family member who’s enrolled in a family plan.
Example: A family plan has an annual deductible of $10,000. Harry’s daughter, Alison, incurs $12,000 in medical expenses. Since the limitation of cost sharing for self-only coverage is embedded in the plan, the plan picks up all of Alison’s medical costs that exceed $6,850, regardless of whether other family members meet the family’s limit on cost sharing.