CMS Releases Cost-sharing Limits for 2025 Plan Years
November 29, 2023
CMS Releases Cost-sharing Limits for 2025 Plan Years

On Nov. 15, 2023, the Centers for Medicare and Medicaid Services (CMS) released the maximum limits on cost sharing for 2025 under the Affordable Care Act (ACA). For 2025, the maximum annual limitation on cost sharing is $9,200 for self-only coverage and $18,400 for family coverage. This represents an approximately 2.6% decrease from the 2024 limits of $9,450 for self-only coverage and $18,900 for family coverage.

  

Out-of-Pocket Maximum

The ACA requires most health plans to comply with annual limits on total enrollee cost sharing for essential health benefits (EHBs). These cost-sharing limits are commonly referred to as an out-of-pocket maximum. Once the out-of-pocket maximum is reached for the year, the enrollee cannot be responsible for additional cost sharing for EHBs for the remainder of the year.


Under the ACA, EHBs must reflect the scope of benefits covered by a typical employer plan and must include items and services in ten general categories, including emergency services, hospitalization, prescription drugs, pediatric services, outpatient care and maternity and newborn care.


CMS annually adjusts the ACA’s out-of-pocket maximum for inflation and publishes the limits by January of the year preceding the applicable benefit year. The ACA’s cost-sharing limits apply to all non-grandfathered health plans, including self-insured health plans, level-funded health plans and fully insured health plans of any size.


Any out-of-pocket expenses required by or on behalf of an enrollee with respect to EHBs must count toward the cost-sharing limit. This includes deductibles, copayments, coinsurance and similar charges but excludes premiums and spending for noncovered services. Health plans that use provider networks are not required to count an enrollee’s expenses for out-of-network benefits toward the cost-sharing limit. Also, the ACA requires health plans to apply an embedded out-of-pocket limit for everyone enrolled in coverage. Each enrollee must have an individual out-of-pocket limit on EHBs that is not higher than the ACA’s out-of-pocket maximum for self-only coverage.


Limits for 2024 and 2025

For plan years beginning in 2024, the out-of-pocket maximum is $9,450 for self-only coverage and $18,900 for family coverage. For plan years beginning in 2025, the limits are $9,200 and $18,400, respectively. Employers should review the plan designs each year to ensure they comply with the ACA’s cost-sharing limits.

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September 2, 2025
Many businesses rely on multiple vendors to manage critical functions such as HR, payroll/HCM, benefits, commercial insurance, and retirement plans. While outsourcing can provide specialized expertise in each area, using separate providers often creates hidden costs that can quietly undermine efficiency, accuracy, and employee satisfaction. Here’s why integration matters, and how a consolidated approach can save time, reduce risk, and improve the employee experience. 1. Increased Administrative Burden When each service is managed by a separate vendor, administrative work multiplies. Employees and HR teams may spend extra hours logging into different systems to process payroll, submit benefits updates, or manage compliance tasks. Reconciling employee information across multiple portals and coordinating communications between vendors creates unnecessary complexity, which can distract your team from strategic priorities. 2. Higher Risk of Errors and Compliance Issues Fragmentation can increase the likelihood of costly mistakes. Payroll errors, mismanaged retirement contributions, and insurance coverage gaps often occur when systems do not communicate effectively. A single misalignment can have a ripple effect: Incorrect payroll deductions Late or missing retirement contributions Gaps in insurance coverage or compliance violations With multiple vendors, the risk of these errors and their consequences rises. 3. Limited Visibility and Reporting When each service lives in its own system, it’s hard to get a complete picture of your workforce. Without centralized reporting, many businesses struggle to: Analyze labor costs or benefits spending accurately Identify compliance gaps or coverage issues Track trends in employee engagement and retention Limited visibility makes it difficult to make informed decisions and optimize operations. 4. Compounded Costs Paying multiple vendors for separate services often results in more than just the sum of their fees. Each system typically comes with its own implementation, training, and subscription costs, which can quickly add up. In addition, internal administrative hours spent managing vendor relationships, reconciling conflicting data, or troubleshooting errors create a hidden expense that is often overlooked. Businesses may also face unexpected costs when trying to integrate or transfer data between disconnected platforms, or when compliance issues arise due to misaligned processes. Over time, these scattered costs compound, reducing overall efficiency and limiting resources that could be better spent on strategic growth initiatives. 5. Frustrated Employees The impact of fragmentation extends to employees. They may face confusion about where to access benefits or payroll information, experience delays in issue resolution, or encounter inconsistent communications. This frustration can lead to disengagement, lower productivity, and higher turnover. Businesses that integrate these functions provide a smoother, more cohesive experience for employees, resulting in higher satisfaction, better engagement, and a stronger workplace culture. Why Integration Matters Integrating HR, payroll/HCM, benefits, commercial insurance, and retirement services with a single partner simplifies operations, reduces errors, improves reporting, and enhances the employee experience. Businesses that consolidate services gain: Streamlined administrative processes and reduced duplication of effort Improved accuracy and compliance through connected systems Enhanced visibility into workforce metrics and financials Cost efficiencies by eliminating overlapping fees and redundant systems A more consistent, positive experience for employees By managing these services in a unified platform, your business can focus on growth instead of juggling multiple systems and vendors. Take the Next Step If your business is managing multiple vendors for HR, payroll, benefits, insurance, and retirement, it’s time to consider a more integrated approach. Streamlining these services with a single, high-touch partner like Simco can save time, reduce risk, and create a better experience for both your team and your employees.
August 25, 2025
As the 2025–26 school year gets underway, many employees are navigating the dual pressures of professional responsibilities and family life. For parents of school-aged children, this can mean adjusting to new routines, handling childcare logistics, and managing the emotional ups and downs that often accompany the start of the year. For employers, this season offers an opportunity to demonstrate support and strengthen employee loyalty. Below are nine strategies businesses can adopt to help their workforce balance work and family demands more effectively. Flexible Work Options Flexibility remains one of the most powerful ways to support working parents. Allowing employees to shift their schedules, such as starting earlier or later, or offering hybrid and remote work options helps parents handle school drop-offs, pickups, and unexpected schedule changes. For example, permitting an employee to work from home two mornings a week may relieve the stress of managing transportation while ensuring business needs are still met. When employees feel trusted to manage both work and family responsibilities, engagement and productivity rise. Back-to-School Support The transition into a new school year often involves extra expenses and planning. Employers can ease this burden by organizing back-to-school supply drives, offering stipends for educational expenses, or sharing curated lists of local resources like tutoring programs or after-school care. Some businesses even host “lunch and learn” sessions on topics such as family budgeting or time management during the school year. These gestures show employees that the company understands their life outside of work and wants to help them succeed in both areas. Prioritize Mental Well-Being Back-to-school season can be stressful for the whole family, with shifting routines, homework expectations, and social adjustments. Employers can proactively support mental health by promoting counseling services, stress management programs, or mindfulness workshops. Offering access to telehealth therapy sessions or creating quiet spaces in the office for breaks can make a tangible difference. Focusing on mental well-being helps employees feel cared for and creates a healthier, more resilient workforce overall. Paid Time Off for School Activities Balancing school commitments with work obligations can be difficult without supportive policies. By providing paid time off specifically for school-related events, such as parent-teacher conferences, school plays, or volunteering opportunities, employers can reduce the guilt or anxiety parents may feel about taking time away from work. Even a few hours of school-activity leave per semester can significantly boost morale and demonstrate the company’s commitment to work-life balance. Childcare Assistance Childcare remains one of the greatest stressors for working parents. Businesses can step in by offering childcare subsidies, backup childcare arrangements for emergencies, or partnerships with local providers to secure discounted rates. Employers with larger workforces may explore on-site childcare facilities or after-school program collaborations. Even simply sharing information about community resources and vetted childcare options can make a big difference for employees struggling to find reliable solutions. Open Communication Encouraging honest, ongoing conversations between managers and employees is essential. Managers should be trained to ask about potential school-year challenges, such as altered availability during drop-off hours or the need to leave for school events, without judgment. Creating a culture where employees feel safe discussing these needs allows managers to find practical solutions, like shifting deadlines or redistributing workloads, that benefit both the employee and the organization. Employee Assistance Programs (EAPs) EAPs are often underutilized, yet they can be invaluable during the school year. These programs typically offer access to counseling, parenting support, financial planning, and more. Employers should not only remind employees that these resources exist but also explain how they can be used during this time of year. For example, highlighting financial counseling services in September, when school-related expenses spike, makes the EAP more relevant and accessible. Family-Friendly Policies Workplace policies should reflect the realities of family life. Review scheduling practices to avoid early morning or late afternoon meetings when parents are often unavailable. Consider policies that allow parents to swap shifts or trade hours with coworkers. Involving employees in creating or revising family-friendly policies ensures the solutions are practical, widely supported, and foster an inclusive culture that values everyone’s needs. Recognition Matters Acknowledging the extra effort parents put in during the school year can have a lasting impact. Recognition doesn’t have to be large-scale, a personal thank-you note, a shout-out during a team meeting, or a small gift card can go a long way toward showing appreciation. Celebrating milestones, like surviving the first week back to school, helps parents feel seen and valued, reinforcing their commitment to the company. The Bottom Line Supporting employees during the school year goes beyond providing benefits; it’s about creating an empathetic, flexible, and responsive workplace culture. By adopting these strategies, businesses not only help their employees manage family responsibilities with confidence but also foster a more engaged, loyal, and productive workforce.
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