November 30, 2021

Volume XI, Number 334

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November 29, 2021

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Reminder: Affordable Care Act's (ACA’s) Out-of-Pocket Limits Differ from HSA-Qualified High Deductible Health Plans (HDHP) Starting in 2015

In April, the IRS released the 2015 inflation adjustments for Health Savings Accounts (HSA) and HSA-qualified high deductible health plans (HDHPs). A month earlier, HHS released details on the “premium adjustment percentage,” which is used to calculate annual increases in cost sharing under the Affordable Care Act’s (ACA) maximum out-of-pocket rules. These ACA rules limit participant cost-sharing under non-grandfathered group health plans for covered, in-network essential health benefits.

For plan years beginning in 2014, the ACA’s maximum out-of-pocket limits were tied to the out-of-pocket limits established for HDHPs. That caused some to assume that the ACA maximum out-of-pocket limits and the HDHP limit would always be the same. But they aren’t. Under the ACA, HHS is required to use a different methodology for calculating any annual adjustments than the IRS uses for HDHPs. Therefore, starting in 2015, the two limits will begin to differ as shown in the first table below. The second table contains other inflation adjustments for HSAs and HDHPs.  In both tables, figures are shown single/family.

 

2015

2014

ACA Out-of-Pocket Limits

$6,600 / $13,200

$6,350 / $12,700

IRS Out-of-Pocket Limits for HDHPs

 $6,450 / $12,900

$6,350 / $12,700

Other HSA-Related Provisions

2015

2014

Annual HSA Contribution Limit

$3,350 / $6,650

$3,300 / $6,550

Minimum Annual HDHP Deductible

$1,300 / $2,600

$1,250 / $2,500

This means that in addition to the HDHP limits being lower than the ACA limits in 2015, expenses will accumulate toward the HDHP limit more quickly because the HDHP limits apply to all covered in-network benefits, not just essential health benefits. Note that under both the ACA and IRS rules, cost-sharing includes deductibles, coinsurance and copayments, and excludes premiums.

One final point – the “premium adjustment percentage” also applies to the employer “pay-or-play” mandate penalties.  That could increase the $2,000 “no coverage” penalty to $2,080 and the $3,000 “unaffordable coverage” penalty to $3,120 starting in 2015; however, the IRS has not officially confirmed these numbers at this time.

Employers should keep an eye out for future adjustments and be sure to review their plan documents and communications materials to make sure the appropriate limits are reflected.

© 2021 Proskauer Rose LLP. National Law Review, Volume IV, Number 130
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About this Author

Paul Hamburger Employee Benefits Law Attorney Proskauer Rose Law Firm
Partner

Paul M. Hamburger is co-chair of the Employee Benefits & Executive Compensation Group and head of the Washington, DC office. Paul is also a leader of the Practice Center’s health and welfare subgroup and a member of Proskauer’s Health Care Reform Task Force.

Paul provides technical knowledge and advice to employers on all aspects of their employee benefit programs, and advises employee benefit plan trustees and service providers on ERISA and employee benefit plan-related matters. He has extensive experience in negotiating service provider...

202.416.5850
Stacy H Barrow, Proskauer Rose Law Firm, Labor Employment Attorney
Associate

Stacy H. Barrow is an Associate in the Labor & Employment Law Department and a member of the Employee Benefits, Executive Compensation and ERISA Litigation Practice Center and the Health Care Reform Task Force, resident in the Boston office.

617-526-9648
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