Affordable Care Act: 2026 Compliance Checklist
The Affordable Care Act (ACA) made widespread reforms to health plan coverage when it was enacted in 2010. Since then, changes have been made to various ACA requirements for employer-sponsored health coverage. These changes include annual cost-of-living increases to certain ACA dollar limits, adjustments to ACA reporting requirements and updates to preventive care coverage guidelines.
Changes to some ACA requirements will take effect in 2026 for employers sponsoring group health plans. For example, the affordability percentage under the ACA’s employer mandate rules for applicable large employers (ALEs) will increase significantly for plan years beginning in 2026, which may provide ALEs with more flexibility when setting their employee contribution rates.
To prepare for 2026, employers can use this checklist to review these ACA requirements and develop a compliance strategy. Employers should ensure that their health plan documents, including the Summary of Benefits and Coverage (SBC), are updated to reflect any new plan limits. Employers should also ensure that up-to-date information is communicated to employees at open enrollment time.
Plan Design Changes
Overall Cost-sharing Limits
Complete
Confirm that your plan’s out-of-pocket limit for essential health benefits (EHB) does not exceed the ACA’s limit for the plan year beginning in 2026.
Effective for plan years beginning on or after Jan. 1, 2026, a health plan’s out-of-pocket limit for EHB may not exceed $10,600 for self-only coverage and $21,200 for family coverage. This limit applies to all non-grandfathered group health plans, including fully insured and self-funded plans. Any out-of-pocket expenses required by or on behalf of an enrollee with respect to EHB must count toward the cost-sharing limit. This includes deductibles, copayments, coinsurance and similar charges but excludes premiums and spending on noncovered services. Also, plans that use provider networks are not required to count an enrollee’s expenses for out-of-network benefits toward the ACA’s cost-sharing limit.
If you have a health savings account (HSA)-compatible high deductible health plan (HDHP), keep in mind that the plan’s out-of-pocket maximum must be lower than the ACA’s limit. For 2026, the out-of-pocket maximum for HDHPs is $8,500 for self-only coverage and $17,000 for family coverage.
Health Flexible Spending Account (FSA) Limits
Complete or N/A
If you have a health FSA, confirm that its dollar limit on employees’ salary reduction contributions will not exceed the adjusted limit for the plan year beginning in 2026.
The ACA imposes a dollar limit on employees’ pre-tax contributions to a health FSA. This limit is indexed each year for cost-of-living adjustments. For plan years beginning in 2026, the health FSA contribution limit is $3,400.
If you have a health FSA that allows carryovers of unused amounts, confirm that the maximum unused amount from a plan year beginning in 2026 that is allowed to be carried over to the immediately following plan year beginning in 2027 does not exceed the adjusted limit.
For plan years beginning in 2026, the health FSA carryover limit is $680.
First-dollar Preventive Care Coverage
Complete
Confirm that your health plan covers the latest recommended preventive care services without imposing any cost sharing.
Non-grandfathered health plans must cover certain preventive health services without imposing cost-sharing requirements when the services are provided by in-network health care providers.
The ACA’s preventive care guidelines are periodically updated based on new medical research and recommendations. For example, plans must expand coverage for preventive care for women to include additional breast cancer imaging or testing and patient navigation services without cost sharing.
Excepted Benefit HRA
Complete or N/A
If you offer an excepted benefit HRA, confirm that its maximum benefit for the plan year beginning in 2026 does not exceed $2,200.
For 2026 plan years, the maximum benefit for excepted benefit HRAs is $2,200.
Grandfathered Plan Status
Complete or N/A
If you have a grandfathered plan, determine whether it will maintain its grandfathered status for the 2026 plan year.
- If losing status, confirm compliance with all ACA requirements for non-grandfathered plans.
- If maintaining status, continue to provide the model notice.
Employer Mandate Rules
ALE Status for 2026
Yes / No
Will you be an ALE for 2026?
ALEs are employers with 50 or more full-time employees (including equivalents) during the prior year.
Offer of Health Plan Coverage
Yes / No
Do you offer health coverage to your full-time employees?
A full-time employee works at least 30 hours per week (or 130 hours per month).
The IRS provides two methods for determining status.
Affordability
Confirm compliance
For 2026, the affordability percentage is 9.96%.
Minimum Value
Confirm compliance
A plan provides minimum value if it covers at least 60% of total allowed costs.
Reporting of Coverage
Deadlines
- March 2, 2026: Individual statement notice
- March 31, 2026: IRS electronic filing deadline
Forms
PCORI Fees
Due July 31, 2026
Employers with self-funded plans must file using Form 720.
Disclosure Requirements
Summary of Benefits and Coverage (SBC)
Provide updated SBC during open enrollment
Exchange Notice
Provide all new hires with a model notice.
Patient Protections Notice
Include required notice in plan materials if applicable.
Links and Resources
Provided to you by Hodge, Hart & Schleifer, Inc.
This Compliance Overview is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. ©2025 Zywave, Inc.