The Department of Health and Human Services (“HHS”) recently issued the “payment parameters” section of its Annual Notice of Benefit and Payment Parameters for 2026. This notice includes updated limits on out-of-pocket expenses — such as deductibles, co-pays, and other charges (excluding premiums) — for employer-sponsored, non-grandfathered health plans beginning in the 2026 plan year.
Additionally, HHS has released a proposed version of the 2026 Benefit and Payment Parameters rule. While this guidance primarily addresses Marketplace coverage, it often includes provisions that can affect employer-sponsored plans. Notably, HHS, along with the Departments of Labor and the Treasury, anticipates upcoming rulemaking to clarify how drug manufacturer support impacts annual cost-sharing limits—potentially affecting employer health coverage. However, it is currently unclear when this guidance will be finalized or what specifics it will entail.
Out-of-Pocket Maximum Changes for 2026
For non-grandfathered health plans starting on or after January 1, 2026, there is a significant increase in the out-of-pocket maximum limits:
- Self-only coverage: $10,150 (up from $9,200 in 2025)
- Other than self-only coverage: $20,300 (up from $18,400 in 2025)
These out-of-pocket maximums differ from the generally lower limits required for high-deductible health plans (“HDHPs”) that qualify for health savings account (“HSA”) contributions.
Employer Next Steps
Employers offering non-grandfathered health plans should adjust their out-of-pocket maximums to meet the 2026 requirements for plan years beginning on or after January 1, 2026.
San Francisco HCSO and FCO Annual Reporting Due by May 2, 2025
San Francisco employers must submit the 2024 HCSO and FCO Employer Annual Reporting Form by May 2, 2025, to avoid penalties and ensure compliance.
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