Published October 7, 2026 · Daniel Griffin, Licensed Independent Advisor · NPN #22052447
The most a marketplace plan can make you pay for covered, in-network care in 2027 is $12,000 for one person and $24,000 for a family. In 2026 it was $10,600 and $21,200. In 2025 it was $9,200. That is a 30% rise in two years, the biggest since the law set the first limit at $6,350 in 2014.
That number is the ceiling on your worst year: after it, the plan pays 100% of covered in-network care until December 31. It is also the number most people never look at when they pick a plan, and the renewal notice arriving this month is where the 2027 version first shows up.
Why It Jumped
The limit is indexed every year by a formula in federal rules. In 2025 HHS changed what the formula tracks: it now follows projected premiums across all private health insurance, rather than employer premiums alone. Private premiums have been rising fast, so the cap rose with them — $1,400 for 2026 and another $1,400 for 2027.
| Plan year | One person | Family |
|---|---|---|
| 2014 | $6,350 | $12,700 |
| 2024 | $9,450 | $18,900 |
| 2025 | $9,200 | $18,400 |
| 2026 | $10,600 | $21,200 |
| 2027 | $12,000 | $24,000 |
Maximum annual limitation on cost sharing, from HHS’s 2027 payment rule (Table 9).
Which Plans Sit Right at the Limit
Plans do not have to go to the limit, but many are built there. Across every 2026 plan sold through HealthCare.gov in the 17 licensed states that use it: 464 of 3,121 plans set their out-of-pocket maximum at exactly $10,600. That includes 28% of Bronze plans and every catastrophic plan. A plan designed at the ceiling has room to follow the ceiling up, so on a Bronze renewal notice, look for this line first.
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Three Things the $12,000 Changes
1. How you compare plans. Add a year of premiums to the out-of-pocket maximum and you have the most each plan can cost you in a bad year. If the extra premium for a richer plan over twelve months is smaller than the gap in out-of-pocket maximums, the richer plan wins every year you actually get sick or hurt.
2. HSAs. The IRS sets its own, lower ceiling for high-deductible plans: $8,700 for one person in 2027. A Silver or Gold plan above that is not HSA-qualified. Every Bronze and catastrophic plan sold to individuals still is, whatever its limit, because the IRS has treated them all as HSA plans since the start of 2026. The 2027 HSA contribution limit is $4,500 for one person and $9,000 for a family.
3. Silver, if your income is modest. Cost-sharing reductions lower the limit on Silver plans only. For 2027 it is $4,000 for one person up to 200% of the poverty line ($31,920) and $9,600 from 200% to 250% ($39,900). Below 250%, a Bronze plan gives that protection away; compare the Silver plan before you default to the cheapest premium.
For Families
The $24,000 family limit is not a single pot one person can drain. No one person pays more than the $12,000 individual limit, and once the family together reaches $24,000 the plan pays in full for everyone. A family where one person has a bad year pays at most $12,000 plus whatever the others use up to the family total.
Comparing 2027 plans? Start with your ZIP.
A licensed agent shows you the worst-year cost of every plan in your county, marketplace and private options together, before December 15.
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Sources
- HHS, Premium Adjustment Percentage, Maximum Annual Limitation on Cost Sharing, Reduced Maximum Annual Limitation on Cost Sharing, and Required Contribution Percentage for the 2027 Benefit Year, January 29, 2026: the $12,000 limit and the $4,000 / $9,600 reduced limits.
- HHS, Notice of Benefit and Payment Parameters for 2027, final rule, Table 9: the limit for every year since 2014.
- HHS, Marketplace Integrity and Affordability final rule, 90 FR 27074 (June 25, 2025): the change to how the limit is indexed.
- IRS, Rev. Proc. 2026-24: 2027 HSA contribution limits and the $8,700 high-deductible plan out-of-pocket ceiling.
- IRS, Notice 2026-5: Bronze and catastrophic plans treated as HSA plans from 2026.
- HHS, 2026 poverty guidelines: the 200% and 250% figures for 2027 coverage.
- CMS, Qualified Health Plan Landscape file, individual market medical, plan year 2026 (data.healthcare.gov): the count of plans at the limit is a coveragebycounty.com analysis of the 17 licensed HealthCare.gov states, counting each plan once.
Out-of-pocket limits apply to covered, in-network care; premiums, out-of-network care and services a plan does not cover do not count toward them. Nothing here is tax advice. Medically underwritten coverage is not available in every state and acceptance depends on health history. Nothing here is an offer of coverage. Daniel Griffin is a licensed independent insurance agent, NPN #22052447, not tied to any single carrier and not affiliated with the U.S. government.