Out-of-Pocket Maximums and Deductible Limits For 2019

Each year the ACA sets new limits for out-of-pocket maximums and deductibles. Here are the limits for 2019 plans for individuals and families.[1][2]

  • For 2019, your out-of-pocket maximum can be no more than $7,900 for an individual plan and $15,800 for a family plan before marketplace subsidies.
  • For 2019, your maximum deductible is the same as the out-of-pocket maximum.
  • The out-of-pocket maximum thresholds are different for HSA eligibility, see the section below.

NOTE: The individual limit applies to each individual in the plan. Thus, for 2019, even though the family limit is $15,800, no one member can occur more than $7,900 in covered expenses before the maximum is reached for that member.

Maximums and Deductibles on HSA-Eligible Plans in 2019

Please note, the minimum deductibles and maximums for HSAs have increased this year (while the minimum deductibles have stayed the same). Keep in mind HSA eligibility thresholds are different than the threshold for maximums in general. See our page on HSAs for 2019 for contribution limits and other information not directly pertaining to deductibles and maximums.[3]

Minimum Deductible for HSA Eligibility

  • Self-only: $1,350
  • Family: $2,700

Maximum Out-of-Pocket Limit for HSA Eligibility

  • Self-only: $6,750
  • Family: $13,500

TIP: The maximums are slightly lower on HSA compatible plans then they are in general on health plans (as you can see above). This has to do with the fact that the rates are raised by different mechanisms. The difference allows for non-HSA compatible high deductible plans. Thus, if you want an HSA, make sure your plan is “HSA Eligible.” The IRS defines high deductible health plans for 2019 in Revenue Procedure 2018-30 [pdf]. Learn more about pairing HSAs with High Deductible Health Plans in 2019.

Citations

  1. out-of-pocket maximum limit. HealthCare.Gov.
  2. Revenue Procedure 2018-30. IRS.gov. PDF
  3. 2019 HSA Limits Rise, IRS Says. Shrm.org.