Plan Design and Cost Containment: A Hub for Employers With 50+ Employees
By Victor Insures You Editorial Team | Reviewed by Victor Morgan, Licensed Agent and Independent Benefits Broker
Victor Insures You LLC, Texas Agency License #2443871 | Victor Morgan, Texas License #1939462
This hub from Victor Insures You explains each plan design lever in plain English, gives the current published figures where they exist, and links to our articles that go deeper.
Plan design is where an employer decides what its health plan actually is: the deductibles, out-of-pocket maximums (both the HDHP out-of-pocket maximum and the ACA out-of-pocket maximum), networks, account options, and the share of premium employees pay. For employers with 50 or more employees, those choices also carry ACA consequences, because contribution levels drive affordability under the employer shared responsibility rules.
This hub from Victor Insures You explains each plan design lever in plain English, gives the current published figures where they exist, and links to our articles that go deeper. Topics marked [Coming soon] are on our editorial calendar. Every article in this pillar is fact-checked and reviewed by Victor Morgan before it is published, and figures are re-verified before each update.
Key 2027 figures at a glance
These are the plan design figures most employers need for 2027 plan years. Confirm each against your plan documents before relying on it.
- ACA affordability percentage: 10.22% (IRS Revenue Procedure 2026-26). The 2026 figure was 9.96% (IRS Revenue Procedure 2025-25, section 3.02).
- HSA contribution maximums: $4,500 self-only and $9,000 family (IRS Revenue Procedure 2026-24), plus a $1,000 catch-up contribution for account holders age 55 or older (26 U.S.C. section 223(b)(3)(B)).
- HDHP minimum deductibles: $1,750 self-only and $3,500 family (IRS Revenue Procedure 2026-24, section 3.01(3)).
- HDHP out-of-pocket maximum: $8,700 self-only and $17,400 family (IRS Revenue Procedure 2026-24).
- ACA out-of-pocket maximum: $12,000 self-only and $24,000 family (CMS 2027 premium adjustment percentage and cost-sharing parameters guidance).
- Health FSA limit: the IRS has not yet released the 2027 figure.
HSA and HDHP limits for 2027
A high-deductible health plan (HDHP) that meets federal requirements lets enrolled employees contribute to a health savings account (HSA). For 2027, the HSA contribution maximums are $4,500 for self-only coverage and $9,000 for family coverage, and account holders age 55 or older can contribute an extra $1,000. The 2027 HDHP minimum deductibles are $1,750 self-only and $3,500 family, and the 2027 HDHP out-of-pocket maximum is $8,700 self-only and $17,400 family.
Plan documents, summaries, and enrollment materials need to reflect the new figures before employees choose coverage. Confused employees sometimes pick the lowest premium without understanding the deductible, or miss out on HSA contributions, so the numbers need a plain explanation as well.
Read more: The Hidden Cost of a Benefits Package Your Employees Don’t Understand
Related: Group HSA plans
ACA out-of-pocket maximum
Separate from the HDHP out-of-pocket maximum, the ACA out-of-pocket maximum caps in-network out-of-pocket costs for covered essential health benefits in non-grandfathered plans. For 2026 plan years the ACA out-of-pocket maximum is $10,600 for self-only coverage and $21,200 for family coverage (prior-year figure in the CMS 2027 guidance). For 2027 the ACA out-of-pocket maximum rises to $12,000 self-only and $24,000 family. An HDHP must also stay under the lower HDHP limit: its own out-of-pocket maximum cannot exceed the 2027 HDHP out-of-pocket maximum of $8,700 self-only and $17,400 family. If benefits change for the new plan year, employees need an updated Summary Plan Description or a Summary of Material Modifications.
Read more: Open Enrollment Is Coming: What HR Leaders Need to Do Right Now
OBBBA changes for 2027 plan design
The One Big Beautiful Bill Act (OBBBA) made several changes that affect plan design. It made the pre-deductible telehealth safe harbor for HDHPs permanent, made direct primary care arrangements compatible with HSAs (fee caps apply), and increased the dependent care flexible spending account (FSA) limit beginning in 2026.
The IRS has not yet released the 2027 health FSA limit, so we do not state a figure. Our planned brief will cover what each OBBBA change means for 2027 plan design.
Read more: [Coming soon]
ICHRA for larger groups
An individual coverage health reimbursement arrangement (ICHRA) lets an employer reimburse employees for individual-market health coverage rather than, or alongside, offering a traditional group plan. For employers with 50 or more employees, an ICHRA raises its own ACA questions, so it has to be modeled carefully rather than assumed to be simpler. Our upcoming article will look at when an ICHRA is worth modeling for a larger group, and when it is not.
Read more: [Coming soon]
Related: Group HRA strategy
Contribution strategy and affordability safe harbors
Contribution strategy decides how premium cost is split between the employer and employees across coverage tiers. For 2027, the ACA affordability percentage is 10.22%, up from 9.96% for 2026. Employers confirm that at least one plan option is affordable using one of three IRS safe harbors: the W-2 method, the rate-of-pay method, or the federal poverty line method.
A higher affordability percentage is a ceiling, not a target. We model employer and employee contributions across tiers during the renewal, and we look closely at the family tier, because that is where employees feel a change in their paychecks.
Read more: Open Enrollment Is Coming: What HR Leaders Need to Do Right Now; Your Benefits Renewal Shouldn’t Be a Surprise: The 150-Day Plan for Employers With 100+ Employees
Networks
The network determines which doctors and hospitals employees can use at in-network cost, and it is one of the most common sources of employee questions: “Is my doctor in network?” Network access can matter to an employer as much as the headline premium, so name it as a non-negotiable before the renewal if it is one. Network structures include PPO, EPO, and HMO plans. A dedicated article comparing network strategies is on our calendar.
Read more: [Coming soon]
Reference-based pricing
Reference-based pricing is an approach in which a plan pays providers based on a benchmark rather than a traditional network discount. It changes how claims are paid and how employees experience billing, so it calls for careful employee communication before and after it starts. Our upcoming article will explain how it works and which employers should evaluate it.
Read more: [Coming soon]
Telehealth and direct primary care
Telehealth gives employees access to care by phone or video, and many benefits packages already include it alongside behavioral health coverage. Under OBBBA, HDHPs can cover telehealth before the deductible under a permanent safe harbor, and direct primary care arrangements can be HSA-compatible, subject to fee caps. Our future article will cover how to add either without disrupting HSA eligibility.
Read more: [Coming soon]
Designing the plan and the renewal together
Contribution strategy, plan design, and negotiation have to be decided together. A change to the deductible shifts the contribution math, and a change in funding arrangement can open plan design options that were not available before. Plan design work also belongs inside the renewal timeline, which starts roughly 150 days before the renewal date, so decisions are final in time for employee communication and benefits education meetings.
Read more: Your Benefits Renewal Shouldn’t Be a Surprise: The 150-Day Plan for Employers With 100+ Employees; What Your October Renewal Actually Locks In (And What You Can Still Negotiate)
Related: Group health insurance plans
How plan design shows up for employees
A plan design only works if employees understand it. The questions HR hears most often are about the difference between a deductible and their plan’s out-of-pocket maximum (the annual cap set within the ACA out-of-pocket maximum, or within the HDHP out-of-pocket maximum on an HDHP), whether a doctor is in network, and why a paycheck changed. Employees who do not understand cost sharing or network rules tend to be surprised by bills after care, and many re-enroll in last year’s plan without comparing options, even when the plans changed.
That is why every plan design change needs a plain-language explanation of what changed at renewal and what employees will pay in common scenarios. The design is only finished when employees can use it.
Read more: The Hidden Cost of a Benefits Package Your Employees Don’t Understand; Open Enrollment Chaos Is Optional: How Employee Navigator Simplifies This Season for HR
Plan design questions to settle before your next renewal
Victor Insures You works through these with HR and finance before the carrier’s proposal arrives:
- Which plan option are we relying on to meet the affordability test, and which safe harbor are we using?
- Does our HDHP meet the 2027 HDHP limits ($1,750 self-only / $3,500 family minimum deductible and $8,700 / $17,400 HDHP out-of-pocket maximum), do all our plans stay within the 2027 ACA out-of-pocket maximum ($12,000 / $24,000), and are our documents updated?
- If we offer an HDHP, are we using the OBBBA telehealth and direct primary care options, and do employees understand the HSA?
- Is our network still the right fit for where our employees live and work?
- What does each design option do to employee cost at the family tier?
Start here
If you are new to this topic, read these in order:
Talk it through with our team
If you are weighing a plan design change for 2027, our team can model the options with you. Book a free 20-minute benefits review.
This article is general information for employers and is not legal, tax, or accounting advice. Confirm requirements with counsel and your plan documents.