On June 23, 2025, a final rule amended the methodology for determining the Affordable Care Act’s (ACA) premium adjustment percentage, which is used to index the out-of-pocket (OOP) maximums for non-grandfathered medical plans and the §4980H penalties for applicable large employers (ALEs). With the 2026 premium adjustment percentage increasing under the revised methodology, the OOP maximums and ALE penalties previously announced last October are also increasing.
Applies To:
- Non-grandfathered medical plans subject to the ACA’s annual OOP maximums
- Applicable large employers (ALEs) subject to potential penalties under §4980H
Go Deeper:
With the premium adjustment percentage being increased for 2026, this is causing both the OOP maximums and ALE penalties to increase. Below is a table of the 2025 amounts along with the 2026 original and revised amounts.
- The revised OOP applies to plan years beginning in 2026.
- The revised ALE penalties apply to calendar year 2026.
|
2025 Amounts |
2026 Original Amounts (Announced Oct. 2024) |
2026 Revised Amounts (Announced Jun. 2025) |
|
|
OOP Max per Person |
$9,200 |
$10,150 |
$10,600 |
|
OOP Max per Family |
$18,400 |
$20,300 |
$21,200 |
|
§4980H(a) ALE Penalty |
$2,900 |
$3,200 |
$3,340 |
|
§4980H(b) ALE Penalty |
$4,350 |
$4,800 |
$5,310 |
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