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Report: Limit on out-of-pocket costs to be delayed a year

A key consumer protection of the Affordable Care Act will have to be delayed by a year, according to a report by the New York Times.

In 2014, scheduled to be the first year of full implementation of the ACA, many group health plans will not have to abide by the rule limiting annual out-of-pocket costs to $6,350 for individuals and $12,700 for families.

That limit will still be in place for care by a hospital or other healthcare provider. But insurers can maintain a separate limit for drug benefits until 2015. In 2014, a patient theoretically could pay $6,350 for care and treatment and another $6,350 for prescription drugs, according to the Times.

Out-of-pocket costs for prescriptions may be even higher for some patients, according to the report, because drug plans with no current limits on out-of-pocket costs can remain without any sort of cap in 2014.

An Obama administration official, speaking anonymously, told the Times the delay is necessary as an administrative accommodation for insurers, who “told us that their computer systems were not set up to aggregate all of a person’s out-of-pocket costs. They asked for more time to comply.”

The delay is one of two key ACA provisions that will go into effect a year later than anticipated. The requirement for large employers to offer healthcare coverage to all full-time employees also will wait until 2015. Employers persuaded the administration to wait, saying they needed more time to meet federal reporting requirements.

The limit on out-of-pocket costs was among the primary motivations President Obama stated during his pursuit of healthcare reform leading up to passage of the ACA. He also wanted to ensure people could not be denied coverage for pre-existing conditions, a measure that remains in place for 2014.

By | 2013-08-14T00:00:00-04:00 August 14th, 2013|Categories: National|0 Comments

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