Announcing 2025 Out-of-pocket maximum (OOPM) for group health plans
The 2025 OOPM represents an 2.6% decrease from the 2024 OOPM parameters.
The Affordable Care Act (ACA) introduced a maximum limit on the amount of cost-sharing (out-of-pocket amounts) that can be imposed on a member during a plan year for essential health benefits. This amount of the out-of-pocket maximum (OOPM) is adjusted annually by HHS.
The 2025 OOPM for group health plans is outlined below:
| OOPM for 2025 plan year | OOPM for 2024 plan year |
| Self-only: $9,200 | Self-only: $9,450 |
| Family: $18,400 | Family: $18,900 |
The 2025 OOPM represents an 2.6% decrease from the 2024 OOPM parameters.
The annual OOPM requirement applies to most non-grandfathered group health plans, regardless of whether the plan is fully insured or self-funded (ASO). It does not apply to grandfathered, Transitional Relief or retiree-only plans.
The OOPM includes copayments, deductibles, and coinsurance amounts associated with both medical and pharmacy covered benefits.
High deductible health plans with health savings accounts (HSAs) have limits that are different, including OOPM, deductible and contribution limits. These limits are historically released in May and the 2025 out-of-pocket, deductible and contribution limits will be communicated once available.