| 2026 | 2027 | |
|---|---|---|
| Self-only | $10,600 | $12,000 |
| Other than self-only (family) | $21,200 | $24,000 |
Lower limits for some silver plans (cost-sharing reductions, 2027)
| Household income | Self-only | Family |
|---|---|---|
| 100% to 200% of the poverty level (94% and 87% variants) | $4,000 | $8,000 |
| 200% to 250% of the poverty level (73% variant) | $9,600 | $19,200 |
Worked example
A plan with a $2,000 deductible, 20% coinsurance and a $12,000 maximum would cost you $9,600 on $40,000 of in-network care. A plan with the same deductible and coinsurance but a $6,000 maximum would cost $6,000. Both are legal under the ACA; the lower maximum is simply a richer plan, usually with a higher premium.
What to know
- It applies to non-grandfathered plans, for covered in-network essential health benefits.
- Premiums, out-of-network charges above allowed amounts and non-covered services do not count (full list).
- On a family plan, no single person has to pay more than the self-only limit ($12,000).
- HSA-eligible plans must meet the lower HDHP maximum.
Source: CMS guidance of January 29, 2026 (2027 benefit year). Checked October 18, 2026.
Related: HDHP out-of-pocket maximum · deductible vs out-of-pocket max · 2027 limits hub.
This is general information, not tax or insurance advice. Confirm details with your plan documents, the IRS and a qualified professional.
General education, not insurance, tax or legal advice. Figures from IRS and HHS publications; confirm with your plan documents.