Welcome to the Illinois Health Matters Blog

What health reform means for the people of Illinois

A blog by IllinoisHealthMatters.org

Tuesday, August 13, 2013

Clearing Up Confusion About Health Reform’s Out-of-Pocket Protections

Recent media coverage may have sown confusion about health reform’s requirement that health insurance plans cap how much consumers can pay out-of-pocket each year for medical care. The bottom line: for many plans, the protections will take effect as scheduled in 2014. Some plans will be able to wait an extra year to fully comply.

The health reform law requires that, starting next year, private insurance plans limit how much in cost-sharing charges — deductibles, copayments, and coinsurance — that people enrolled in a plan must pay each year for covered benefits provided by the plan’s network of health care providers. (This includes plans offered in the individual market or through employers. The requirement doesn’t apply to “grandfathered” plans.) In 2014, this “maximum out-of-pocket limit” will be $6,350 for an individual and $12,700 for a family.

Back in February, the Obama Administration provided an additional year to fully comply with this requirement but only for certain plans offered by employers.

Here are some clarifications about the February policy:

Health insurance plans in the individual market: In 2014, the maximum out-of-pocket limit will apply, as scheduled, to the individual (non-group) health insurance market. Millions of people are expected to gain coverage in this market in 2014, as health reform’s new improvements and federal subsidies significantly increase access to affordable coverage.

Employer-sponsored health insurance plans: The maximum out-of-pocket limit will also continue to generally apply to non-grandfathered plans offered by employers, including small group, large group, and self-insured plans. Employer plans that have a single insurer or administrator have to fully comply with the limit next year.

Employer plans that have “separately administered” benefits: The Administration provided the exception in February for these plans, in which an employer has one insurer or administrator for its primary package of health benefits and a different insurer or administrator for discrete benefits, such as prescription drugs. Because employers and insurers have claimed it will be difficult to coordinate an overall maximum out-of-pocket limit across separately administered benefits, they sought and received the ability to avoid full compliance for one year.

Even those employer plans with “separately administered” benefits that qualify for the delay still must apply some out-of-pocket limits in 2014. As the February guidance explained, these plans must ensure that their primary package of health benefits has an out-of-pocket limit of no more than $6,350 for individuals and $12,700 for families. A separately administered benefit, such as prescription drugs, that already has an existing limit on out-of-pocket costs must comply with the limits of $6,350 for individuals and $12,700 for families in 2014.

An employer plan wouldn’t have to add a cap to a separate benefit if the separate benefit currently lacks one. But this exception shouldn’t be misunderstood as broadly waiving the important out-of-pocket protection that health reform will bring in 2014.

Sarah Lueck

Sarah Lueck
Center on Budget and Policy Priorities

(This was originally posted here on the Off the Charts Blog)


21 comments:

  1. Shop for carbonmonoxide detectors and more home safety products. Save money. Live better.

    ReplyDelete
  2. All the Health Insurance policies protect people from hospitalization bills. However, besides the cost of hospitalization, people need to find out money for food or refreshment when a person is hospitalised.

    ReplyDelete
  3. Wellness is about being comfortable in your space: your body, your attitude, and your environment. A healthy lifestyle can greatly increase a person’s longevity.

    Health Blog

    ReplyDelete
  4. Many psychiatrists in private practice don't take insurance, or don't 'accept assignment.' They require the to patient pay them and then the patient can submit to his health insurance company and
    insurance claims network

    ReplyDelete
  5. Amazing how simple it can be to communicate with people and have them understand a certain topic, you made my day.

    St. Augustine School of Medical Assistants

    ReplyDelete
  6. Buy Diabetes care Products online Diabetes Care Products with best prices and quality. Shop online best diabetes care products with cod and free shipping at elecwire.com

    ReplyDelete
  7. I love that it is about the fellowship and team work as opposed to anything else.



    Corona Dentist

    ReplyDelete
  8. Very nice article, Thanks for sharing.

    -PPLIC

    ReplyDelete
  9. Very interesting to read, I've got a lot of information out of this .Prudential life

    ReplyDelete
  10. We have an Amazing Body ... Know a fact About our Body and be motivated in lives..:)
    https://play.google.com/store/apps/details?id=com.bendeb.bodyfacts

    ReplyDelete
  11. Silver Bird Marketing is a best source of UK for Personal Injury Leads, Road Traffic Accident Leads, and Personal Injury Lead Generation. Give us a try for your personal injury leads requirements.

    ReplyDelete
  12. Really impressive article. Thanks for sharing.
    Check this out too:
    Medisoft

    ReplyDelete
  13. Our personal injury leads are delivered to you as part of a grander marketing programme that you'll undertake though our consultancy service.If you want more clients, our leads are second to see leadsbank.co.uk

    ReplyDelete
  14. I appreciate your Views, I have found Some More Factors while Surfing around the web about the Topic It will be helpfull for you.

    vitamins for kids - HealthAid is one of UK’s premier manufacturers of nutritionally balanced supplements. HealthAid is a market leader with over 25 years of experience in nutritional health and a over 500 products.

    ReplyDelete
  15. Very Very excellent and useful publish. Thank's to talk about your experience with us. I will try to keep in thoughts these recommendations in my weblog writing reviews procedure.

    Health Insurance - Texas Health Insurance Now is an independent insurance agency that provides insurance information to individuals, families and small businesses to who are in need.

    ReplyDelete
  16. Congratulations! This is the best factor, Thank you so much for trying to talk about this exciting information.

    blood pressure info - Info on high blood pressure that can save your life is included here. Find out what it is and how to overcome high blood pressure.

    ReplyDelete
  17. This comment has been removed by the author.

    ReplyDelete
  18. This comment has been removed by the author.

    ReplyDelete
  19. Great site! I am loving it!! Will be back later to read some more. I am taking your feeds also.quality denture repairs
    New denture repairs Chicago

    ReplyDelete
  20. Axowa UK's awesome services can help your

    business rise to the top! Get the freshest leads

    that converts! Check these pages out: Funeral Plan Leads, Life Insurance Leads, Pension Leads, PMI Leads, Prepaid Funeral Plan

    Leads

    ReplyDelete