The 2027 ACA out-of-pocket maximum is $12,000 for self-only coverage and $24,000 for family coverage. These are not projections anymore. CMS finalized them on January 29, 2026 in the HHS Notice of Benefit and Payment Parameters for 2027. That is a jump of $1,400 for an individual and $2,800 for a family over the 2026 limits of $10,600 and $21,200, a 13.2% increase in a single year. If you buy a Marketplace plan, this is the most you can be required to pay in-network for covered essential health benefits before your insurer picks up 100% of the rest.
The headline number matters less than what it means for your actual bill. Most people never hit the cap. But the cap defines your worst-case year, and for 2027 the worst case got meaningfully more expensive.
2027 ACA Out-of-Pocket Maximum at a Glance
| Coverage type | 2026 limit | 2027 limit | Increase |
|---|
| Self-only | $10,600 | $12,000 | +$1,400 (13.2%) |
| Family (other than self-only) | $21,200 | $24,000 | +$2,800 (13.2%) |
These are the ceilings. Insurers can offer plans with lower out-of-pocket maximums, and many do. No non-grandfathered plan can set a higher one, with two exceptions covered below.
Why the Limit Jumped So Much
The out-of-pocket maximum is indexed to something called the premium adjustment percentage, which tracks how much average per-person private health insurance premiums have grown since 2013. For the 2027 benefit year, CMS set that figure at 1.8916224814, meaning premiums have grown roughly 89.2% between 2013 and 2026.
Two consecutive years of large increases have reset the baseline. Look at the history:
| Plan year | Self-only limit | Family limit | Year-over-year change |
|---|
| 2023 | $9,100 | $18,200 | +4.6% |
| 2024 | $9,450 | $18,900 | +3.8% |
| 2025 | $9,200 | $18,400 | -2.6% |
| 2026 | $10,600 | $21,200 | +15.2% |
| 2027 | $12,000 | $24,000 | +13.2% |
The 2025 dip was an anomaly. CMS changed the underlying premium data source that year, which temporarily lowered the index. When the agency shifted back to a measure that captured actual employer and individual-market premium growth, the limit snapped upward. In two years, the self-only cap has climbed from $9,200 to $12,000, a 30% increase.
Cost-Sharing Reduction Caps for 2027
If your household income is between 100% and 250% of the federal poverty level and you enroll in a silver plan through the Marketplace, you qualify for cost-sharing reductions. CSRs lower your out-of-pocket maximum well below the standard cap. They are automatic, but only on silver plans. Pick bronze or gold and you lose them.
| Household income (% FPL) | 2027 self-only OOP max | 2027 family OOP max | Reduction |
|---|
| 100% to 200% FPL | $4,000 | $8,000 | Two-thirds off |
| Over 200% to 250% FPL | $9,600 | $19,200 | One-fifth off |
| Over 250% FPL (no CSR) | $12,000 | $24,000 | None |
A single adult at 175% FPL on a silver plan has a 2027 worst-case exposure of $4,000. The same person on a bronze plan is exposed to $12,000, or potentially more. That is the single most consequential plan-selection decision for anyone under 250% FPL, and it is routinely missed because bronze premiums look cheaper on the shopping page.
CSRs also reduce deductibles and copays, not just the annual cap. The savings are real and they are the reason silver plans are usually the right answer for lower-income enrollees even when a bronze plan has a $0 premium.
Two Plans That Can Exceed $12,000 in 2027
CMS finalized two changes for the 2027 plan year that allow certain plans to blow past the standard cap.
Bronze plans with a 130% MOOP. Starting in 2027, an insurer that already offers at least one compliant bronze plan may also offer a bronze plan with an out-of-pocket maximum of up to 130% of the statutory limit, if that is needed to hit bronze actuarial value. For 2027 that works out to $15,600 self-only and $31,200 family. Rising medical costs made it mathematically hard for insurers to design a bronze plan that stays at 60% actuarial value without either a huge deductible or a higher cap, so CMS gave them the higher cap.
Catastrophic plans. CMS also finalized a rule requiring catastrophic plans to pay no benefits (beyond preventive care and three primary-care visits) until the enrollee has spent 130% of the maximum annual limitation on cost sharing. For 2027 that is the same $15,600 threshold for an individual.
The practical takeaway: in 2027, "ACA plan" no longer automatically means "capped at $12,000." Read the summary of benefits and coverage. Check the out-of-pocket maximum line item. Do not assume.
ACA Cap vs. HSA-Qualified HDHP Cap in 2027
People often confuse the ACA out-of-pocket maximum with the IRS limit for HSA-qualified high-deductible health plans. They are different rules from different agencies, and the IRS limit is lower.
| Limit | 2027 self-only | 2027 family | Set by |
|---|
| ACA maximum out-of-pocket | $12,000 | $24,000 | CMS (2027 NBPP) |
| HSA-qualified HDHP out-of-pocket max | $8,700 | $17,400 | IRS (Rev. Proc. 2026-24) |
| HDHP minimum deductible | $1,750 | $3,500 | IRS |
| HSA contribution limit | $4,500 | $9,000 | IRS |
A plan that wants to be HSA-eligible in 2027 must keep its out-of-pocket maximum at or below $8,700 for self-only coverage, even though the ACA would permit $12,000. If you are shopping for an HSA-compatible Marketplace plan, the tighter IRS number is the one that binds.
What Counts Toward the Out-of-Pocket Maximum
Counts toward the cap:
- Your deductible
- Copayments for covered services
- Coinsurance for covered services
- In-network essential health benefit costs, including prescriptions
Does not count toward the cap:
- Monthly premiums
- Out-of-network care (unless your plan chooses to count it)
- Balance billing amounts above the allowed charge
- Services your plan does not cover at all, like most adult dental or cosmetic procedures
- Costs above the plan's coverage limits
The family cap has an embedded protection people forget: no single individual within a family plan can be required to pay more than the self-only limit, $12,000 in 2027, even if the family cap is $24,000. If one family member has a catastrophic year, their personal spending stops at the individual limit.
The Bigger 2027 Picture
The out-of-pocket maximum increase is landing at the same time as two other pressures on Marketplace enrollees.
Enhanced premium tax credits expired at the end of 2025. The American Rescue Plan subsidy expansion, extended through 2025 by the Inflation Reduction Act, was not renewed. Subsidies reverted to the original ACA schedule, which restored the 400% FPL income cliff and raised the percentage of income enrollees are expected to contribute. Many households saw premiums rise sharply for 2026 and are seeing similar pressure for 2027.
The caps and the credits move in opposite directions. Premiums are higher, subsidies are smaller, and the maximum you can be asked to pay in a bad year is $12,000 instead of $9,200 two years ago. The gap between "insured" and "protected from financial catastrophe" widened.
This makes the silver-plan CSR question more important than it has ever been. If your income puts you under 250% FPL, the difference between silver and bronze in 2027 is the difference between a $4,000 worst case and a $15,600 worst case. Run the numbers on total annual cost, not just premium.
How to Check Your 2027 Out-of-Pocket Maximum
- Confirm your projected 2027 household income. Use modified adjusted gross income for everyone on your tax return. Estimate the full calendar year, not your current paycheck rate.
- Convert that to a percentage of the 2027 federal poverty level. Marketplace eligibility for 2027 coverage uses the FPL guidelines published in early 2026.
- If you land between 100% and 250% FPL, filter to silver plans only. CSRs apply nowhere else. Healthcare.gov shows the reduced out-of-pocket maximum on the plan card once your income is entered.
- Read the actual out-of-pocket maximum on each plan. Do not assume it equals $12,000. Some bronze plans in 2027 will show $15,600 or another figure up to that ceiling.
- Check whether the plan is HSA-eligible if you want to contribute to a health savings account. That requires an out-of-pocket maximum of $8,700 or less for self-only coverage.
- Add premium plus out-of-pocket maximum to see your true worst-case annual cost, then compare plans on that number.
Open enrollment for 2027 coverage runs from November 1, 2026 through mid-January 2027 in most states, with a January 1 effective date for plans selected by December 15, 2026. State-based Marketplaces sometimes run longer windows.
Frequently Asked Questions
What is the ACA out-of-pocket maximum for 2027?
$12,000 for self-only coverage and $24,000 for family coverage. CMS finalized these limits on January 29, 2026 in the HHS Notice of Benefit and Payment Parameters for 2027. They apply to all non-grandfathered individual and group health plans with plan years beginning in 2027.
How much did the ACA out-of-pocket maximum increase from 2026 to 2027?
It rose 13.2%. The self-only limit went from $10,600 to $12,000, and the family limit went from $21,200 to $24,000. This follows a 15.2% increase from 2025 to 2026, so the self-only cap has climbed about 30% in two years.
Can a Marketplace plan have an out-of-pocket maximum above $12,000 in 2027?
Yes, in two specific cases. Insurers may offer a bronze plan with an out-of-pocket maximum of up to $15,600 (130% of the standard limit) as long as they also offer at least one bronze plan at or under the standard cap. Catastrophic plans in 2027 also pay no benefits until an enrollee reaches 130% of the cap. Check each plan's summary of benefits.
What is the 2027 out-of-pocket maximum with cost-sharing reductions?
For silver plan enrollees between 100% and 200% of the federal poverty level, the 2027 cap is $4,000 self-only and $8,000 family. For enrollees over 200% up to 250% FPL, it is $9,600 self-only and $19,200 family. CSRs apply only to silver plans purchased through the Marketplace.
Do premiums count toward the out-of-pocket maximum?
No. Monthly premiums never count toward the out-of-pocket maximum. Neither do out-of-network charges, balance billing above the allowed amount, or services your plan does not cover. Only deductibles, copays, and coinsurance for covered in-network essential health benefits count.
Is the ACA out-of-pocket maximum the same as the HSA limit?
No. For 2027, the IRS caps out-of-pocket spending on HSA-qualified high-deductible plans at $8,700 self-only and $17,400 family, well below the ACA limits of $12,000 and $24,000. A plan must meet the lower IRS threshold to be HSA-eligible.
Does one family member have to pay the full $24,000 family maximum?
No. Within a family plan, no single individual can be required to pay more than the self-only limit, which is $12,000 in 2027. The $24,000 figure is the ceiling for the household as a whole.
When do the 2027 limits take effect?
For plan years beginning on or after January 1, 2027. Most individual Marketplace plans run on a calendar year, so the new limits apply starting January 1, 2027. Employer plans with non-calendar plan years apply them at the start of their 2027 plan year.
Sources
- CMS, HHS Notice of Benefit and Payment Parameters for 2027 Final Rule (issued January 29, 2026)
- CMS, 2027 Premium Adjustment Percentage and Parameters Guidance
- IRS Revenue Procedure 2026-24 (2027 HSA and HDHP inflation adjustments)
- HealthCare.gov, out-of-pocket maximum definition and cost-sharing reduction rules
