PPACA Marketplace Update:
 2015 Cost Sharing Limitations - Finalized and Released




On March 5th, the Department of Health and Human Services (HHS) released the final "Notice of Benefit and Payment Parameters" for 2015.  This final rule included the finalized out-of-pocket (OOP) maximum limits on cost sharing, maximum deductible limitations, and the national annual limit on cost sharing for stand-alone dental plans (SADPs) for the pediatric dental essential health benefit (EHB) fro 2015.


For 2015, the out of pocket maximum on cost sharing is:

  • $6600 for self-only coverage (up from $6350 in 2014)
  • $13,200 for coverage other than self-only (up from $12,700 in 2014)


For 2015, the final maximum deductible limitations that are only applicable to the small group market:

  • $2050 for self-only coverage (up from $2000 in 2014)
  • $4100 for coverage other than self-only (up from $4000 in 2014)


The final 2015 out-of-pocket maximum limits for Health Savings Accounts (HSA) compatiable High Deductible Health Plans (HDHP) are expected to be released from the IRS in mid-2015


For 2015, the national annual limits on cost sharing for stand-alone dental plans covering pediatric dental (as an Essential Health Benefit) offered through the Marketplace are:

  • $350 for one covered child (down from $700 in 2014)
  • $700 for for two or more covered children (down from $1400 in 2014)
The actuarial value (AV) requirement for stand-alone dental plans offered on the Marketplace must meet either the 70 percent or 85 percent AV level standard.  You can CLICK HERE to review the final rule and get more information.


We will continue to keep you informed about the nuances of the Marketplace as we experience them.  If you have any questions or concerns about these processes please contact Altruis Benefit Consulting at 877.442.5878 or info@altruisbenefit.com





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