U.S. CapitolTo help clients keep track of the various limitations associated with health care reform, the MedBen Compliance team has compiled “ACA by the Numbers,” a downloadable summary of the key financial components under the Affordable Care Act. The limitations listed in the summary apply as of the first day of a health plan’s 2021 plan year.
While it’s important to be aware of all the limitations, we’ll highlight one here: Standard Plan In-Network Out-of-Pocket Maximums. For 2021, the limitations are:
  • $8,550 for self-only (employee-only) coverage
  • $17,100 for other than self-only coverage
  • Over these thresholds, employers must pay 100% of the benefits covered by the plan.
This represents an increase from the 2020 limitations of $8,150 self-only coverage and $16,300 for coverage other than self-only. For employers, this enables them to increase the out-of-pocket maximums, thereby raising the threshold at which the employer must cover 100% of benefits covered under the plan.
MedBen is available to assist clients with their ACA compliance questions. Director of Compliance and Medical Management Erin Kelly at 740-522-7368 or ekelly@medben.com.