$6,350 Individual/$12,700 Family

Non-grandfathered plans that cover essential health benefits (EHBs) must limit member out-of-pocket expenses for EHBs (in-network) to $6,350 for individual plans and $12,700 for family plans. This applies to plan years beginning on or after Jan. 1, 2014.

The Affordable Care Act (ACA) requires that in-network EHB out-of-pocket expenses for non-grandfathered plans not exceed out-of-pocket (OOP) limits set by the IRS for high deductible health plans (HDHPs). These amounts are indexed annually. On May 2, 2013, the IRS officially announced the 2014 HDHP out-of-pocket limits. This established out-of-pocket limits for non-grandfathered plans that cover essential health benefits in 2014.