A non-grandfathered group health plan’s in-network out-of-pocket maximum for essential health benefits (EHBs) for the 2021 plan year cannot exceed $8,550 for self-only coverage and $17,100 for other than self-only coverage. 1 This is an increase of approximately 4.9% percent from 2020. The in-network out-of-pocket maximum applies to all individuals, regardless of whether an individual has a self-only plan or other-than-single coverage.
Self-funded group health plans are not required to cover EHBs. But, if they do, they cannot impose lifetime or annual dollar limits on those benefits.
For high-deductible health plans (HDHPs) for the 2021 plan year, the out-of-pocket limit will be $7,000 for self-only coverage and $14,000 for other-than self-only coverage.2 The minimum deductible is not changing from 2020, remaining $1,400 for self-only coverage and $2,800 for other than self-only coverage.
1 Notice of Benefit and Payment Parameters for 2021, Final Rule from the U.S. Department of Health and Human Services, May 14, 2020
2 Rev. Proc. 2020-32 from the IRS, April 30, 2020