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ACA Limits Have Increased for 2023: Time to Start Planning

June 21, 2022

The Department Health and Human Services Announced Increased Health Plan Out-of-Pocket Limits by Over 4%

The 2023 Health Insurance renewal season is under way and those employers that are currently at the Affordable Care Act (ACA) limits will find additional room in their plan designs for the upcoming 2023 plan year.

The Department of Health and Human Services (HHS) recently announced updates to the maximum out-of-pocket limits for Affordable Care Act (ACA) compliant plans.

The limit for plans that only cover employees has increased to $9,100 per year. This 2023 limit represents a 4% increase over the self only limit of $8,750 currently in place for 2022.

Family plans, which cover an employee plus any of their dependents, will have higher limits.

The maximum out of pocket limit for Affordable Care Act (ACA) compliant family plans rose to $18,200 in 2023. The 2022 maximum is $17,400 for family Affordable Care Act (ACA) compliant plans. The 2023 family maximum is rising by 4.6% versus the 2022 out of pocket limit.

Year 2023 2022
Maximum out-of-pocket for ACA-compliant plans (HHS) Self-only: $9,100

Family: $18,200

Self-only: $8,750

Family: $17,400

For more information, view the Department of Health and Human Services (HHS), Center for Medicare & Medicaid Services FULL RELEASE HERE.

What does this mean for fully insured or level-funded groups?

Employers that are enrolled in a fully insured or level-funded health insurance program are subject to these out-of-pocket maximum limits, based on the plan design options sold to them by the group health insurance carriers.

For organizations looking to lower their health insurance premiums, moving to a group health plan with a higher out of pocket maximum is one option to significantly lower the fixed insurance costs of that employer.

How could a MERP help?

While moving to the plan design with the higher out of pocket maximum will lower the fixed insurance premiums, the costs to employees when they use the healthcare system will also rise proportionally.

Many employers choose to subsidize the health plan out of pocket costs by utilizing a Medical Expense Reimbursement Plan (MERP). Account based plans, such as the Medical Expense Reimbursement Plan (MERP), are a great tool for employers to keep their fixed insurance premiums low, while maintain great benefits for employees.

The Medical Expense Reimbursement Plan provides funding to employees and their dependents and is only used when they actually need to use the healthcare system.

Any funds that are not spent by members are kept by the employer as savings to their health benefits budget.

Interested in learning more?

For more information on the impacts of higher out of pocket maximum limits in 2023 and the Medical Expense Reimbursement strategy, email sales@differencecard.com or visit our website at www.differencecard.com.

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