The Centers for Medicare and Medicaid Services (CMS) has announced new cost-sharing limits and required contribution percentages for the 2025 benefit year. For the 2025 calendar year, the self-only coverage annual limitation on cost-sharing is $9,200. It is $18,400 for other than self-only coverage.
For benefit year 2025, the maximum annual limitation on cost sharing is $3,050 for enrollees with household income equal to or greater than 100 percent of the federal poverty level (FPL) and less than or equal to 150 percent of the FPL. It is also $3,050 for enrollees with household income greater than 150 percent of FPL and less than or equal to 200 percent of FPL. It is $7,350 for enrollees with household income greater than 200 percent and less than or equal to 250 percent of FPL.
In the 2025 benefit year, the amount an employer may charge workers for employer-provided health insurance will be 7.28 percent of a worker’s income.
Prospects: These cost-sharing limits, required by the Affordable Care Act (ACA), are important to an employer calculating whether to pay a shared responsibility payment for not offering ACA-compliant health insurance, or for offering noncompliant health coverage. The CMS memo explains the methodology by which the agency determined these cost-sharing limits.
NAIFA Staff Contact: Michael Hedge – Senior Director – Government Relations, at mhedge@naifa.org.