Questions billers ask › What is the 2026 maximum annual limit on cost sharing?

What is the 2026 maximum annual limit on cost sharing?

Answered from the public Medicare sources on 2026-09-15. The quoted text is the source; the note beneath it is what our AI found. You decide what applies to your claim.

The rule, word for word

“Under § 156.130(a)(2)(i), for PY 2026, cost sharing for self-only coverage may not exceed the dollar limit for calendar year 2014 increased by an amount equal to the product of that amount and the premium adjustment percentage for PY 2026. Under § 156.130(a)(2)(ii), for other than self-only coverage, the limit is twice the dollar limit for self-only coverage. Under § 156.130(d), these amounts must be rounded down to the next lowest multiple of $50. Using the proposed premium adjustment percentage of 1.6726771319 for PY 2026, and the 2014 maximum annual limitation on cost sharing of $6,350 for self-only coverage, which was published by the IRS on May 2, 2013, 225 in the proposed rule (90 FR 12993), we proposed that the PY 2026 maximum annual limitation on cost sharing would be $10,600 for self-only coverage and $21,200 for other than self-only coverage. We stated in the proposed rule that this represents approximately a 15.2 percent increase from the PY 2025 parameters of $9,200 for self-only coverage and $18,400 for other than self-only coverage, and approximately a 4.4 percent increase from the previously published PY 2026 parameters of $10,150 for self-only coverage and $20,300 for other than self-only coverage. 226 225 See IRS. (n.d.) Rev. Proc. 2013-25. Dep't of Treasury. http://www.irs.gov/pub/irs-drop/rp-13-25.pdf. 225 See IRS. (n.d.) Rev. Proc. 2013-25. Dep't of [...]”

Federal Register, document 2025-11606, 45 CFR § 156.130(a)(2)(i) (a. Maximum Annual Limitation on Cost Sharing for PY 2026)
Published2025-06-25 Captured2025-06-25
sha256:5c986fe5…7046d190 · Source

What our AI found in the sources

The PY 2026 maximum annual limitation on cost sharing is $10,600 for self-only coverage and $21,200 for other than self-only coverage. These amounts are calculated under 45 CFR § 156.130(a)(2) using the 2014 base limit of $6,350 increased by the PY 2026 premium adjustment percentage of 1.6726771319, then rounded down to the next lowest multiple of $50. This represents approximately a 15.2 percent increase from the PY 2025 parameters.

Also cited

Federal Register, document 2025-04083, 45 CFR § 156.130(a)(2)(i) (a. Maximum Annual Limitation on Cost Sharing for PY 2026)
Published2025-03-19 Captured2025-03-19
sha256:71ddfb0e…a3743e62 · Source

If this comes up on one of your claims

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