Which 2026 ACA Adjustments Apply to Healthcare Plans in Puerto Rico?

In Revenue Procedure 2025-25, the IRS announced the 2026 indexed adjustments to the required contribution percentage to be used for determining if an individual is eligible for affordable employer-sponsored minimum essential coverage, which, in turn, impacts whether the individual is eligible for health insurance premium assistance credits under Section 36B of the United States Internal Revenue Code of 1986, as amended (the “Code”), for the purchase of healthcare coverage through the ACA Marketplace or Exchange.  And in Revenue Procedure 2025-26, the IRS announced the 2026 indexed adjustments to the penalties on applicable large employers for violations of the employer shared responsibility requirements of Code § 4980H.

These 2026 indexed adjustments do not apply to healthcare plans in operation in Puerto Rico because:

1. Puerto Rico residents cannot purchase healthcare through the ACA Marketplace or Exchange [https://www.healthcare.gov/puerto-rico/]. Therefore, they are ineligible for premium assistance credits under Code § 36B [see, Code § 7701(a)(9), which in defining the term “United States” generally used for purposes of the Code expressly excludes U.S. territories, such as Puerto Rico]; and
2. The employer shared responsibility requirements of Code § 4980H do not apply in Puerto Rico and Puerto Rico employees are disregarded in determining whether a U.S. employer is subject to such requirements and the amount of any penalties for related compliance failures [see, Treas. Reg. § 54.4980H-1(a)(24)(ii)(C) and 79 Fed. Reg. 8569 (February 12, 2014)]. In fact, employers doing business in Puerto Rico are not legally required to offer healthcare benefits to their Puerto Rio employees and there are no federal or local fines or penalties on employers that do not offer healthcare.

On the other hand, since the Public Health Service Act (“PHSA”) applies in Puerto Rico [PHSA § 2791(d)(14), which in defining the term “States” includes Puerto Rico], healthcare plans in operation in Puerto Rico are subject to limitation on cost-sharing requirements of PHSA § 2707(b), as periodically adjusted by Centers for Medicare & Medicaid Services of the U.S. Department of Health and Human Services [for the 2026 limits, see 90 Fed. Reg. 27168 (June 25, 2025)].

Accordingly, for plan year 2026, annual cost sharing on in-network essential health benefits covered by healthcare plans in operation in Puerto Rico cannot exceed $10,600 for plan participants with self-only coverage and $21,200 for plan participants with coverage other than self-only, such as family coverage.