Affordable Care Act Cost-Sharing and High Deductible Health Plan Limits for 2016

Starmark® self-funded plan designs’ in-network out-of-pocket limits have been updated to incorporate the 2016 ACA cost-sharing and high-deductible health plan changes. The in-network out-of-pocket limits for 2016 plan years are:

  • PPO plans (Not HSA Qualified)
    • Individual: $6,850
    • Family: $13,700
  • CDHPs
    • Individual: $6,550
    • Family: $13,100
  • The ACA individual out-of-pocket limit of $6,850 will apply to individuals covered under family coverage with an HDHP (this is a new requirement in 2016).
  • For plans with a calendar-year benefit period, services received during the calendar year prior to the start of the new 2016 plan year may exceed the $6,850 cost-sharing limit.

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