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ACA Deductible Limits Repealed

On April 1, 2014, President Obama signed the Protecting Access to Medicare Act retroactively effective to March 2010 in compliance with the Affordable Care Act (ACA).  The Act adds provisions to preserve the reimbursement rates for doctors who treat Medicare patients and delays the deadline for the International Classification of Diseases codes for an additional year.  While this Act mainly focuses on Medicare rates for doctors, it also eliminates the ACA's annual deductible limit in the small group market.


Annual Deductible Limits

Originally, the ACA's annual deductible limit was effective for all plan years beginning on or after January 1, 2014.  Plans that began on 1/1/14 or after were not allowed to exceed $2,000 for self-only coverage and $4,000 for family coverage.  The deductible limit repeal provides you, the small group employer, the flexibility to select health plans with higher deductibles.  If your plan began in 2014, it isn't likely you will be affected by the repeal of the ACA's deductible limit until the following renewal. 

Out-of-Pocket Maximums 

The out-of-pocket maximum, which includes the deductible amount, will still limit the cost-sharing in small employer health plans.  The annual limit applies to all non-grandfathered, self-insured and insured health plans regardless of size. For plan years beginning January 1, 2014 or after, the out-of-pocket maximum may not exceed:

  • $6,350 for employee only coverage; and
  • $12,700 for family coverage

As of 2015, the Department of Health and Human Services (HHS) has made the announcement that the out-of-pocket maximum will increase to:

  • $6,600 for employee only coverage
  • $12,200 for family coverage