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Consumer Groups Speaking Out Against High Out-of-Pocket Limits

Under the Affordable Care Act (ACA), as of January 1, health insurance plans are to impose a cap on the amount of money consumers can be required to pay for out-of-pocket costs such as prescription drugs and co-payments. The amount of the cap is estimated to be about $6,250 for an individual policy holder. However, consumer advocacy groups want Americans to know that the enforcement date of this provision of the ACA has been delayed by a year.

According to a Kaiser Health News article, the Obama administration granted this year-long extension because some employer-offered health plans have “separate policies or benefit managers for different parts of their coverage, such as medical care and drugs, and sometimes a third for children’s dental services. Some employer plans have separate out-of-pocket caps for each of the coverage areas.” Insurers and employers require extra time to figure out how they are going to make adjustments to their plans, merge these caps, and ultimately comply with the health reform law.

Certain consumer groups are saying this is all hogwash, citing that technology exists that would make it easy for health insurance companies to comply. Patient advocates from over 40 groups, including the American Cancer Society Action Network and the National Health Council collectively wrote a letter to the administration, speaking to the huge importance of out-of-pocket limits in ensuring that Americans have quality coverage that will not cause financial ruin in case of a medical condition. Consumer groups urged the government to revise the expressed policy for 2014 and keep it consistent with the original intent of the Affordable Care Act.


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