Reform Alert - News from the Blues' Office of National Health Reform

Changes to cost sharing limits coming in 2015

Updated: April 3, 2014 - Small group maximum deductible limitations repealed

Updated: March 13, 2014 - 2015 cost sharing limitations finalized and released.

Feb. 11, 2014

On Nov. 25, 2013, the Department of Health and Human Services (HHS) proposed the cost sharing limitations for 2015 cost sharing limitations.

The proposed out-of-pocket maximums are:

  • $6,750 for self-only coverage (an increase from $6,350 in 2014)
  • $13,500 for coverage other than self-only (an increase from $12,700 in 2014)

The proposed 2015 annual maximum deductible limitations that are only applicable to the small group market are:

  • $2,150 for self-only coverage (an increase from $2,000 in 2014)
  • $4,300 for coverage other than self-only (an increase from $4,000 in 2014)

Out-of-pocket maximum limits are linked to high-deductible health plans, and the final amounts are expected to be released in early to mid-2015.

The proposed cost limits for stand-alone dental plans covering pediatric dental (as essential health benefits) offered through the Marketplace are:

  • $300 for one covered child (decrease from $700 in 2014)
  • $400 for two or more covered children (decrease from $1,400 in 2014)

HHS is also proposing to remove the actuarial value requirement for stand-alone dental plans offered through the Marketplace.

Where can I find more information?

More information can be found in the draft Notice of Benefit and Payment Parameters for 2015.

The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an educational tool only and does not replace a more rigorous review of the law's applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. As required by US Treasury Regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code.

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