The 2027 ACA out-of-pocket maximum is $12,000 for self-only coverage and $24,000 for any other coverage, such as a family plan. CMS published both figures in its January 29, 2026 guidance, and HealthCare.gov lists them for plans sold from November 1, 2026. They are 13.2% above the 2026 limits of $10,600 and $21,200, because the 2027 premium adjustment percentage is 1.8916224814.
Adults under 65 comparing 2027 Marketplace plans should use the maximum as the worst case for a bad medical year, then add the yearly premium. Below, the 2027 limit is broken out by plan type, income tier and family size, with the status of the new bronze exception. For income and subsidy lines, see ACA income limits for 2027 coverage.
Coverage Breakdown
Direct answer: the 2027 ACA out-of-pocket maximum
Yes. For 2027 plans, the ACA caps what you pay for covered in-network care at $12,000 for one person and $24,000 for a family. Premiums do not count toward it. CMS finalized a bronze exception of up to $15,600, but a federal court stayed it on July 16, 2026, so 2027 bronze plans stay within $12,000 unless a court lifts the stay.
What counts toward the 2027 out-of-pocket maximum
HealthCare.gov defines the out-of-pocket maximum as the most you have to pay for covered services in a plan year. Deductibles, copayments and coinsurance for in-network care count toward the 2027 limit of $12,000 for one person or $24,000 for a family. After you reach it, your plan pays 100% of the allowed amount for covered in-network benefits for the rest of the plan year.
Several costs never count toward the 2027 limit, so your real spending in a bad year can exceed it. Check each item below before you compare plans.
- Counts: deductibles, copayments and coinsurance for covered in-network care.
- Does not count: your monthly premiums.
- Does not count: services your plan does not cover.
- Does not count: out-of-network care.
- Does not count: charges above the allowed amount that a provider may bill you.
How the 2027 family limit of $24,000 works
Under 45 CFR 156.130, the 2027 limit for coverage that is not self-only is twice the self-only limit, which is $24,000. An individual covered inside a family plan also cannot be asked to pay more than the self-only limit of $12,000 in 2027, so one very sick family member cannot use up the whole family maximum.
Worked example: a family of four on a 2027 plan has a $24,000 family limit. If one child has surgery and the child's in-network costs reach $12,000 in 2027, the plan pays 100% of that child's covered in-network care for the rest of the year, even though the family total is only $12,000. The other three members still have their own spending counted until the family reaches $24,000.
2027 limit comparison: lower limits with silver cost-sharing reductions
Adults under 65 whose household income is 100% to 250% of the federal poverty level for 2027 coverage can qualify for cost-sharing reductions, but only on silver plans. CMS set the reduced 2027 limits at $4,000 for one person ($8,000 for a family) for incomes of 100% to 200% FPL, and $9,600 for one person ($19,200 for a family) above 200% up to 250% FPL.
For 2027 coverage, 250% FPL is $39,900 for one person, using the 2026 poverty guideline of $15,960. Cost-sharing reductions are separate from the premium tax credit, and a bronze or gold plan does not get them. See the Silver 87 cost-sharing reduction tier for how the deductible and copays change.
The 2027 bronze exception of $15,600 and the court stay
CMS's 2027 Payment Notice, effective July 20, 2026, let an insurer that offers a compliant bronze plan also offer bronze plans in the same service area with an out-of-pocket limit above the standard one, up to 130% of it: $15,600 for one person in 2027. CMS says the bronze change applies starting in plan year 2027.
On July 16, 2026, Judge Brendan Hurson of the U.S. District Court for the District of Maryland stayed eight provisions of the rule, including the higher bronze limit. The provisions are not being implemented while the case continues. We found no ruling lifting the stay as of November 13, 2026, so plan on $12,000 for one person and $24,000 for a family on a bronze plan, and confirm the number in the plan details on HealthCare.gov before you enroll.
How the 2027 limit compares with 2026
The 2026 ACA out-of-pocket maximum is $10,600 for one person and $21,200 for a family, and the 2027 maximum is $12,000 and $24,000. CMS calculates the cap from the 2014 limit of $6,350 and the premium adjustment percentage, then rounds down to the next multiple of $50. Plans that renew in 2027 can set a lower limit than the maximum, so the number on your plan may differ.
Alternatives if a $12,000 limit is more than you can pay
The standard 2027 limit is a ceiling, and several routes can lower what you risk paying in a bad year. Compare the yearly premium plus the plan's out-of-pocket maximum, not the premium alone. Each option below lists where to check it.
- Silver plan with cost-sharing reductions: for 2027 coverage, incomes of 100% to 200% FPL get a $4,000 limit and above 200% up to 250% FPL get $9,600 for one person. Check at HealthCare.gov.
- Medicaid or CHIP: in a state that expanded Medicaid, adults under 138% FPL ($22,025 for one person, 2026 guideline) may qualify for Medicaid instead of a Marketplace plan. Check your state agency through HealthCare.gov.
- A plan with a lower limit than the maximum: insurers may set a limit under $12,000 for one person in 2027. Compare each plan's summary of benefits on HealthCare.gov.
- Job-based coverage: if your employer offers a group plan, the same ACA limit applies to its in-network essential health benefits. Ask your plan administrator for the summary of benefits and coverage.
How to find the limit on a 2027 plan and enroll
Open enrollment for 2027 coverage began November 1, 2026 and ends January 15, 2027 on HealthCare.gov. HealthCare.gov lists December 15, 2026 as the deadline for coverage that starts January 1, 2027, and that deadline is in litigation, so confirm the dates there. Every ACA-compliant plan shows its out-of-pocket maximum for one person and for a family in the plan details.
Frequently Asked Questions
What is the ACA out-of-pocket maximum for 2027?
For 2027 plans, the maximum is $12,000 for one person and $24,000 for a family, according to HealthCare.gov and CMS guidance dated January 29, 2026. It covers deductibles, copays and coinsurance for in-network care. Premiums, out-of-network care and services your plan does not cover do not count toward it.
What was the ACA out-of-pocket maximum in 2026?
The 2026 limit is $10,600 for one person and $21,200 for a family, per HealthCare.gov. The 2027 limit of $12,000 and $24,000 is about 13.2% higher. Your 2026 plan keeps its own 2026 limit through the end of the 2026 plan year, and the 2027 limit applies when the plan year starts in 2027.
What is the bronze plan out-of-pocket maximum for 2027?
In 2027 a bronze plan has to stay within $12,000 for one person and $24,000 for a family. CMS finalized an exception allowing bronze plans up to $15,600 for one person, but a federal court stayed it on July 16, 2026. We found no ruling lifting the stay as of November 13, 2026, so confirm in your plan details.
Do premiums count toward the 2027 out-of-pocket maximum?
No. HealthCare.gov says monthly premiums do not count toward the out-of-pocket maximum. Only your deductible, copayments and coinsurance for covered in-network care count in 2027. Add the plan's yearly premium to its out-of-pocket maximum to see the most you could pay in a plan year for covered in-network care.
Is the $24,000 family limit shared, or does each person have a limit?
Both apply in 2027. The family limit is $24,000, but no one person on the plan can be asked to pay more than the self-only limit of $12,000. Once one person reaches $12,000, the plan pays that person's covered in-network care at 100% even if the family has not reached $24,000.
Is the out-of-pocket maximum lower with cost-sharing reductions in 2027?
Yes, on silver plans. CMS set the 2027 reduced limits at $4,000 for one person ($8,000 family) for incomes of 100% to 200% FPL, and $9,600 ($19,200 family) above 200% up to 250% FPL. For 2027 coverage, 250% FPL is $39,900 for one person. Bronze and gold plans do not get these reductions.
Can my plan's out-of-pocket maximum be lower than the federal limit?
Yes. The $12,000 and $24,000 amounts are the highest a 2027 plan can set, not the amounts every plan charges. Insurers can choose a lower limit, and many do. Compare the out-of-pocket maximum shown in each plan's details on HealthCare.gov, along with the deductible and yearly premium, before you enroll.
When does 2027 open enrollment end?
Open enrollment for 2027 coverage runs November 1, 2026 to January 15, 2027 on HealthCare.gov. HealthCare.gov lists December 15, 2026 as the deadline for coverage that starts January 1, 2027, and that deadline is in litigation, so check the dates page on HealthCare.gov before you rely on it.
