SECTION7. EMPLOYEECOSTSHARING OUT-OF-POCKETMAXIMUMAMOUNTS • Mostcoveredworkersareinaplanthatpartiallyortotallylimitsthecostsharingthataplanenrolleemustpayinayear. Theselimitsaregenerallyreferredtoasout-of-pocketmaximumamounts. TheAffordableCareAct(ACA)requiresthat non-grandfatheredhealthplanshaveanout-of-pocketmaximumof$7,150orlessforsinglecoverageand$14,300 3 for family coverage. Manyplanshavecomplexout-of-pocketstructures,whichmakesitdifficulttoaccuratelycollect informationonthiselementofplandesign. • In 2017, 98%percentofcoveredworkersareinaplanwithanout-of-pocketmaximumforsinglecoverage. Thisisa significantincreasefrom87%in2012[Figure7.42]. • Forcoveredworkersinplanswithout-of-pocketmaximumsforsinglecoverage,thereiswidevariationinspending limits. – Fifteenpercentofcoveredworkersinplanswithanout-of-pocketmaximumforsinglecoveragehavean out-of-pocketmaximumoflessthan$2,000,while21%haveanout-of-pocketmaximumof$6,000ormore[Figure 7.44]. 3 ForthoseenrolledinanHDHP/HSA,theout-of-pocketmaximumis$6,550foranindividualplanand$13,100forafamilyplan. The Kaiser Family Foundation and Health Research & Educational Trust / Page 127