Out-of-pocket maximum (OOPM) requirement announced for 2026
The annual OOPM requirement applies to most non-grandfathered group health plans.
The 2025 out-of-pocket maximum (OOPM) for group health plans is outlined below:
| OOPM for 2026 plan year | OOPM for 2025 plan year |
Self-only: $10,150 |
Self-only: $9,200 |
| Family: $20,300 | Family: $18,400 |
The 2026 OOPM represents a 10.3% increase over the 2025 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 2026 out-of-pocket, deductible and contribution limits will be communicated once available.
Share
