ACA Cost Sharing Rules

Summary

This practice note describes the cost sharing limitations imposed by the Patient Protection and Affordable Care Act (P.L. 111-148), as amended by the Health Care Education and Reconciliation Act (Pub. L. No. 111-152) (ACA), as incorporated into the Public Health Service Act (PHS Act), the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code (I.R.C.). The ACA limits cost sharing requirements of non-grandfathered group health plans by imposing a cap on the out-of-pocket expenses covered individuals must pay for essential health benefits in any plan year.