2027 out-of-pocket maximum for health plans
For 2027, the most a health plan can make you pay out of pocket for covered in-network care is $12,000 for one person and $24,000 for a family. Both are 13.2% higher than 2026.
- Out-of-pocket maximum, self-only$12,0002026: $10,600
- Out-of-pocket maximum, family$24,0002026: $21,200
- Most one person pays on a family plan$12,000The self-only limit applies to each person
- Limit for HSA-qualified plans, self-only / family$8,700 / $17,400
Which plans it covers
The limit applies to non-grandfathered health plans, which covers marketplace plans and most job-based plans. It applies to plan years that begin in 2027, so a job-based plan that renews in July uses the 2027 limit from July. Open enrollment on the marketplaces for 2027 coverage starts November 1, 2026.
What counts toward the limit:
- Your deductible
- Copays and coinsurance for covered care
- Prescription drugs covered by the plan
What doesn’t count: premiums, care the plan doesn’t cover, and usually out-of-network care.
| Item | 2026 | 2027 | Change |
|---|---|---|---|
| ACA limit, self-only | $10,600 | $12,000 | +$1,400 (13.2%) |
| ACA limit, family | $21,200 | $24,000 | +$2,800 (13.2%) |
| HSA-qualified plan limit, self-onlyAn HSA plan must meet this lower limit | $8,500 | $8,700 | +$200 (2.4%) |
| HSA-qualified plan limit, family | $17,000 | $17,400 | +$400 (2.4%) |
Common questions
What is the maximum out-of-pocket for 2027?
For plan years starting in 2027, an ACA-compliant plan can make you pay at most $12,000 for in-network covered care for one person, or $24,000 for a family. Many plans set lower limits.
Do premiums count toward the out-of-pocket maximum?
No. The limit covers deductibles, copays and coinsurance for covered in-network care. Your monthly premium is on top of it.
If one person on a family plan has a big bill, do we pay up to the family limit?
No. Each person’s costs are capped at the self-only limit, $12,000, even on a family plan. The family limit caps the total for everyone together.
Does the limit apply to out-of-network care?
Not by law. Plans can count out-of-network costs toward a separate, higher limit or not cap them at all, except for emergency care, which follows in-network rules.
Does this limit apply to Medicare?
No. Original Medicare has no out-of-pocket limit, and Medicare Advantage plans have their own caps. Medicare drug plans have a separate cap of $2,400 in 2027.
Sources
- 2027 premium adjustment percentage and maximum annual limitation on cost sharing, Centers for Medicare & Medicaid Services, Jan 29, 2026
- 2027 HSA, HDHP, and excepted-benefit HRA figures set, Mercer, May 29, 2026
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