2025 Maximum Annual Limits on Cost-Sharing

The U.S. Department of Health and Human Services (“HHS”) and the Centers for Medicare & Medicaid Services (CMS) have issued the 2025 annual dollar limits on cost-sharing.

The notice outlines the upcoming annual maximum cost-sharing on the amount that an enrollee in a non-grandfathered health plan, including self-insured health plans, must pay for essential health benefits through cost-sharing.

The 2025 ACA annual limit on cost-sharing will decrease to $9,200 for self-only coverage and $18,400 for coverage other than self-only. As reference, the 2024 final cost-sharing limits are $9,450 (self) and $18,900 (other). In general, cost-sharing includes deductibles, coinsurance, copayments, and any other required expenditure that is a qualified medical expense with respect to essential health benefits covered under the plan.