2027 Out-of-Pocket Maximum Limits Increase for Employer Health Plans

The U.S. Department of Health and Human Services (HHS) has released the 2027 Notice of Benefit and Payment Parameters, outlining key updates that impact employer-sponsored health coverage. Among the most important changes are the revised annual out-of-pocket (OOP) maximum limits for non-grandfathered group health plans.

Higher Out-of-Pocket Limits for 2027

Beginning with plan years that start on or after January 1, 2027, employers offering non-grandfathered group medical plans must apply updated caps on participants’ out-of-pocket expenses. These limits include deductibles, copayments, and coinsurance—but exclude premium costs.

The newly announced thresholds are:

  • $12,000 for individual (self-only) coverage, an increase from $10,600 in 2026

  • $24,000 for family or other-than-self-only coverage, up from $21,200 in 2026

This adjustment reflects a notable year-over-year rise, continuing the trend of increasing healthcare cost-sharing limits.

Important Distinction for HDHPs and HSAs

It’s important for employers and plan sponsors to recognize that these OOP maximums apply specifically to non-grandfathered group health plans. They are separate from—and typically higher than—the limits established for high-deductible health plans (HDHPs) that are designed to be compatible with health savings accounts (HSAs).

Employers offering HDHPs should continue to follow IRS-issued limits for HSA-qualified plans, which may differ from the HHS parameters.

What Employers Should Do Now

Organizations sponsoring group health plans should begin preparing for these changes well in advance of the 2027 plan year. Key action steps include:

  • Reviewing current plan designs and cost-sharing structures

  • Updating out-of-pocket maximum limits to meet new federal requirements

  • Coordinating with benefits administrators and carriers to ensure compliance

  • Communicating upcoming changes clearly to employees during open enrollment

Final Thoughts

The increase in out-of-pocket maximums for 2027 highlights the ongoing evolution of healthcare cost structures. Employers should stay proactive in monitoring regulatory updates and adjusting plan offerings to remain compliant while supporting employee financial well-being.

Mark C