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

2015 cost sharing limitations finalized and released

Updated: April 25, 2014 - IRS provides guidance on 2015 High Deductible Health Plans Out-of-Pocket Maximum Limits

March 13, 2014

On March 5, the Department of Health and Human Services (HHS) released the final Notice of Benefit and Payment Parameters for 2015. This final rule included the finalized out-of-pocket maximum limits on cost sharing, maximum deductible limitations, and the national annual limit on cost sharing for stand-alone dental plans (SADPs) for the pediatric dental essential health benefit (EHB) for 2015.

For 2015, the out of pocket maximum on cost sharing is:

  • $6,600 for self-only coverage (up from $6,350 in 2014)
  • $13,200 for coverage other than self-only (up from $12,700 in 2014)

For 2015, the final maximum deductible limitations that are only applicable to the small group market are:

  • $2,050 for self-only coverage (up from $2,000 in 2014)
  • $4,100 for coverage other than self-only (up from $4,000 in 2014)

The final 2015 out-of-pocket maximum limits for health savings account (HSA) compatible high deductible health plans are expected to be released by the Internal Revenue Service in mid-2015.

For 2015, the national annual limits on cost sharing for stand-alone dental plans covering pediatric dental (as an essential health benefit) offered through the Marketplace are:

  • $350 for one covered child (reduced from $700 for 2014), and
  • $700 for two or more covered children (reduced from $1,400 for 2014)

The actuarial value (AV) requirement for stand-alone dental plans offered on the Marketplace must meet either the 70 percent or 85 percent AV level standard.

Where can I find more information?

More information can be found in the Final Rule.


The information on this website is based on BCBSM's review of the national health care reform legislation and is not intended to impart legal advice. Interpretations of the reform legislation vary, and efforts will be made to present and update accurate information. 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. Analysis is ongoing and additional guidance is also anticipated from the Department of Health and Human Services. Additionally, some reform regulations may differ for particular members enrolled in certain programs such as the Federal Employee Program, and those members are encouraged to consult with their benefit administrators for specific details.