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Delay on cap of out-of-pocket healthcare costs affects many but not all

Imgres
@patriciaborns  One of the greatest burdens of rising health insurance costs has been not the monthly premium, but the deductible -- the amount you have to pay out of your own pocket before your coverage for most services begins. While healthcare premium prices have risen about 30 percent since 2008, deductibles have risen by over 70 percent. The Affordable Care Act promised to cap those out-of-pocket costs to $6,350 for individuals and $12,700 for families. 

But last week, the New York Times revealed that the Obama administration has postponed the out-of-pocket cap requirement for group plans offered through employers until 2015.

Administration officials told the Times that insurers were having trouble complying with the cap because many use different providers to manage medical and prescription benefits on the same policy, with each provider setting its own deductible rules. They asked. and received, more time to retool for the ACA.

Net net for consumers: Shop carefully. Many healthcare plans will be offering separate benefits for medical services and prescription drugs, each with different out-of-pocket costs that won't be capped in 2014.  For example, the out-of-pocket maximum could be $6,350 for doctors and hospital services, and $3,000 for medications. The sum of those two deductibles is what you'll really be forking over.

The delay affects those who get their health insurance from group plans offered by their employers, which is a lot of people. It won't affect consumers shopping for individual healthcare plans that will be offered on the exchange scheduled to open Oct. 1.

Forbes reports that healthcare providers and consumer groups long knew about and protested the delay to no avail, as was the case with the groups that wrote this letter to Health and Human Services Secretary Kathleen Sebelius. 

 Watch a discussion of the delay with Kaiser Health News reporter Julie Appleby:

 

 

 

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