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Table of Important Yearly Health Insurance Maximums, Penalties, Fees, Etc

The table below provides a single resource for all relevant health insurance related limits, thresholds, fees, penalties, etc published by industry regulators.

  20162017201820192020
Health Plan Cost Sharing LimitIndividual
Family
$6,850
$13,700
$7,150
$14,300
$7,350
$14,700
$7,900
$15,800
$8,150
$16,300
HDHP Minimum DeductibleIndividual
Family
$1,300
$2,600
$1,300
$2,600
$1,350
$2,700
$1,350
$2,700
$1,400
$2,800
HDHP Max Out-of-PocketIndividual
Family
$6,550
$13,100
$6,500
$13,100
$6,650
$13,300
$6,750
$13,500
$6,900
$13,800
HSA Contribution LimitIndividual
Family
Catch-Up (55yo+)
$3,350
$6,750
$1,000
$3,400
$6,750
$1,000
$3,450
$6,900
$1,000
$3,500
$7,000
$1,000
$3,550
$7,100
$1,000
FSA Salary Reduction LimitPer Person$2,550$2,600$2,650$2,700$2,750
Self-Funded Plan PCORI Fee (PMPY)PY Ending Jan-Sep
PY Ending Oct-Dec
$2.17
$2.26
$2.26
$2.39
$2.39
$2.45
$2.45
n/a
n/a
n/a
Employer Mandate Penalties (PEPY)4980H(a) - No Offer
4980H(b) - Not Affordable, Min Value
$2,160
$3,240
$2,260
$3,390
$2,320
$3,480
$2,500
$3,750
$2,570
$3,860
Employer Mandate Penalties (PEPM)4980H(a) - No Offer
4980H(b) - Not Affordable, Min Value
$180.00
$270.00
$188.33
$282.50
$193.33
$290.00
$208.33
$312.50
$214.17
$321.67
Employer Mandate Affordability Safe HarborsFPL ($/mo) for PY on/before Jan
FPL ($/mo) for PY Feb-Dec
Form W-2 (% of wages)
Rate of Pay (% of rate)
$94.74
$95.63
9.66%
9.66%
$95.93
$97.38
9.69%
9.69%
$96.08
$96.72
9.56%
9.56%
$99.75
$102.63
9.86%
9.86%
$101.79
tbd
9.78%
9.78%
Federal Poverty Line (for Exchange Subsidy)Single Household
Each Additional Person
$11,880
$4,140
$12,060
$4,180
$12,140
$4,320
$12,490
$4,420
tbd
tbd
Individual Mandate Penalty Variables (monthly)National Avg Bronze Plan Premium
Monthly Penalty Amt - Flat $ for Adults
Monthly Penalty Amt - % of Excess Income
$223
$695
2.5%
$272
$695
2.5%
$283
$695
2.5%
tbd
$0
0.0%
tbd
$0
0.0%

Under the Employer Mandate, employers with 50+ employees are subject to penalties if they do not offer coverage or if their coverage is not adequate and/or affordable. The penalties are triggered if a full time employee purchases exchange coverage with a subsidy. HHS sends a subsidy notification letter (see sample on this page) to employers for each employee who claims a subsidy during the calendar year. The IRS sends Letter 226J to notify employers about the payment assessment. The employer responds with Form 14764 (response to the letter) and Form 14765 (listing of employees receiving subsidy). The payments are computed on a monthly basis and totaled for the year. The penalty for employers who do not offer coverage is the product of the number of full time employees minus 30 and the per employee penalty amount. Employers can estimate their penalty liability using the IRS ESRP Estimator tool.

The Employer Mandate affordability safe harbors apply on a plan year basis. The affordability percentage applicable to each calendar month is determined by the year in which the plan year for that month began. The Federal Poverty Line safe harbor requires employers to use any poverty guideline “in effect within six months before the first day of the plan year.” Poverty guidelines for each calendar year are typically published by HHS in late January of the same calendar year. Thus, plans with January anniversary dates use the Federal Poverty Line for the prior calendar year for purposes of the FPL safe harbor.

To determine Premium Tax Credits (aka Exchange Subsidies) for a calendar year, the IRS uses the Federal Poverty guidelines applicable to the prior calendar year.

The Federal Poverty guidelines summarized in this article apply to the 48 contiguous states and DC; they exclude AK and HI.

The Individual Mandate penalty is the lesser of and greater of three variables involving the national average bronze plan premium, household income, and a flat dollar amount. You can use the IRS ISRP Estimator tool to estimate potential penalties. The Tax Cuts and Jobs Act of 2017 did not eliminate the individual mandate. It reduced the penalty amount to $0 indefinitely. The framework is still in place.

References:

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