Under the Afford­able Care Act, car­ri­ers are allowed to amend their plan designs each year under an infla­tion fac­tor to keep their “expo­sure” constant,which means that the expo­sure for the patient will increase to also keep his expo­sure con­stant.  For 2020, the out-of-pock­et max­i­mum allowed is $8,150 for indi­vid­ual cov­er­age and $16,300 for fam­i­ly coverage.

When CMS announced these new lim­its, they also said that start­ing in 2020 plans are per­mit­ted, but not required, to exclude drug man­u­fac­tur­er coupons from count­ing toward a cov­ered person’s annu­al out of pock­et max­i­mum IF a med­ical­ly-appro­pri­ate gener­ic drug is available.