Each year, the IRS adjusts the out-of-pocket maximums for ACA health insurance plans based on cost-of-living and healthcare inflation. Understanding the 2027 limits — and how they compare to 2026 — helps you plan your healthcare budget and choose the right plan during Open Enrollment.
What Is an Out-of-Pocket Maximum?
The out-of-pocket maximum (OOPM) is the most you’ll pay for covered healthcare services in a plan year. Once you reach this amount (through deductibles, copays, and coinsurance), your insurance pays 100% of covered costs for the remainder of the year. This is your financial backstop against catastrophic healthcare costs.
The ACA requires all marketplace plans to have an out-of-pocket maximum that doesn’t exceed the federal limits for that year.
2027 Federal Out-of-Pocket Maximum Limits (Projected)
The IRS announces official OOPM limits for 2027 in mid-2026. Based on recent trends (typically 3–5% annual increases), expect the 2027 limits to be approximately:
- Individual: ~$9,450–$9,700 (2026 limit was approximately $9,200)
- Family: ~$18,900–$19,400 (2026 limit was approximately $18,400)
(Confirm actual 2027 limits when they’re officially published on IRS.gov.)
How the OOPM Affects Your Plan Choice
The OOPM is especially important for people with high healthcare use — chronic conditions, planned surgeries, or large families with frequent care. When comparing plans:
- Bronze plans typically have OOPMs near the federal maximum and high deductibles
- Gold and Platinum plans have significantly lower OOPMs and deductibles
- Silver plans with CSRs can have dramatically reduced OOPMs for qualifying income levels
Calculate your worst-case total cost (premium × 12 + OOPM) for each plan tier. This is the maximum you could ever spend in a year on that plan. For people with significant healthcare needs, the difference in OOPM between a Bronze and Gold plan can outweigh the premium savings.
Individual vs. Family Deductibles
For family plans, there are two deductible structures:
- Embedded: Each family member has an individual deductible (lower than the family maximum). One person’s high healthcare use doesn’t require the full family deductible to be met first.
- Aggregate: The family shares one combined deductible. Less protective for families where one member has high healthcare use.
Check which structure applies to plans you’re considering — the same plan can look very different under these two structures for families with mixed healthcare needs.
Want to understand how 2027 deductibles and out-of-pocket costs affect your plan options? Contact Paul at Garden State Benefits for a no-cost, no-obligation review of your 2027 options — he’s a licensed independent broker serving individuals and families across 26 states.