Deductible and Out-of-Pocket Maximums

Applicable Dollar Limits for Group Health Plans
Cost sharing, coinsurance amounts, maximum allowable deductibles, and out-of-pocket expense maximums vary by product type, health plan, and calendar year. 

For plan-specific information, you should refer clients to their Schedule of Benefits, Summary Plan Description, or Summary of Benefits and Coverage (SBC) for their selected health plan.

The 2020 deductible and out-of-pocket limits for various products are as follows:

  • Deductible and out-of-pocket maximums for ACA-compliant plans: $8,150 self-only, $16,300 family
  • High Deductible Health Plan (HDHP) deductible minimum: $1,400 self-only, $2,800 family
  • HDHP out-of-pocket cost (deductibles, copays, and other amounts, excluding premium) maximum: $6,900 self-only, $13,800 family
Health Savings Account (HSA), Health Reimbursement Account (HRA), and Flexible Spending Account contribution maximums also vary annually.

For the 2020 calendar year, the following maximum allowable contributions apply:
  • HSA: $3,550 self/$7,100 family
  • Health (or Health Care) FSA: Employer sets funding limitations. However, the maximum allowable amount cannot exceed $2,750
  • Dependent Care FSA: The maximum allowable amount is $5,000 per household.
  • HRA: Employer sets funding limitations

FSA “Use-it-or-Lose-it” Rule Modification
On 10/31/2013, the Treasury Department and IRS issued a notice and fact sheet announcing a major change to the long-standing Flexible Spending Accounts (FSA) Use-it-or-Lose-it Rule.  
This modification to the rule permits plans to allow participants to carry over $500 annually. Employers cannot have both a grace period and this annual $500 carry over. Employers who want to take advantage of this annual $500 carry over must amend their plans to eliminate their current grace period.