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2023 Maximum Out-of-Pocket Limits Released

January 11, 2022

The Affordable Care Act (ACA) requires non-grandfathered health plans to comply with a maximum annual limitation on cost sharing for Essential Health Benefits. The Department of Health and Human Services (HHS) released the maximum out-of-pocket limits for 2023: $9,100 for self-only coverage and $18,200 for family coverage. This represents a 4.6% increase over the current limits of $8,700 and $17,400, respectively, for 2022 plans.

Previously these amounts were included in the annual Notice of Benefit and Payment Parameters for the applicable year – typically published midyear. However, stakeholders urged HHS to publish these amounts sooner to assist insurers in developing products and rates without having to wait for the annual payment notice. Therefore, for the 2023 benefit year and beyond, HHS has indicated they will publish the these amounts no later than January of the year preceding the applicable year.

The IRS has yet to release information on what the 2023 requirements will be for high deductible health plans (HDHPs) and health savings accounts (HSAs). These amounts are typically published in May or June of the year prior to the applicable year. The HDHP / HSA requirements include a minimum deductible, a maximum out-of-pocket limit and a maximum HSA contribution amount. These requirements apply to both grandfathered and non-grandfathered group health plans.

Therefore, employers who offer HDHP / HSA plans that are not grandfathered are subject to both sets of requirements and need to comply with the lesser out-of-pocket maximums.

Reach out to your Hylant representative for further information. Don’t have one? Contact us here.

The above information does not constitute advice. Always contact your employee benefits broker or trusted adviser for insurance-related questions.

Holly Wahl Senior Vice President, Employee Benefits Compliance Leader

Holly leads Hylant’s ongoing efforts to provide our clients with compliance consulting services on new developments as well as ongoing requirements affecting health and welfare plans. She possesses a deep understanding of federal and state regulations pertaining to employee benefit plans, as well as extensive experience in group benefit plan operation.

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