By Robert Pear
The New York Times, August 12, 2013
In another setback for President Obamaās health care initiative, the administration has delayed until 2015 a significant consumer protection in the law that limits how much people may have to spend on their own health care.
The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014.
Under the policy, many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctorsā services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager.
Some consumers may have to pay even more, as some group health plans will not be required to impose any limit on a patientās out-of-pocket costs for drugs next year. If a drug plan does not currently have a limit on out-of-pocket costs, it will not have to impose one for 2014, federal officials said Monday.
The health law, signed more than three years ago by Mr. Obama, clearly established a single overall limit on out-of-pocket costs for each individual or family. But federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs.
In many cases, the companies have separate computer systems that cannot communicate with one another.
http://www.nytimes.com/2013/08/13/us/a-limit-on-consumer-costs-is-delayed-in-health-care-law.html?ref=politics&_r=0&pagewanted=all
FAQs about Affordable Care Act Implementation Part XII
United States Department of Labor, February 20, 2013
Q2: Who must comply with the annual limitation on out-of-pocket maximums under PHS Act section 2707(b)?
The Departments have determined that, only for the first plan year beginning on or after January 1, 2014, where a group health plan or group health insurance issuer utilizes more than one service provider to administer benefits that are subject to the annual limitation on out-of-pocket maximums under section 2707(a) or 2707(b), the Departments will consider the annual limitation on out-of-pocket maximums to be satisfied if both of the following conditions are satisfied:
a. The plan complies with the requirements with respect to its major medical coverage (excluding, for example, prescription drug coverage and pediatric dental coverage); and
b. To the extent the plan or any health insurance coverage includes an out-of-pocket maximum on coverage that does not consist solely of major medical coverage (for example, if a separate out-of-pocket maximum applies with respect to prescription drug coverage), such out-of-pocket maximum does not exceed the dollar amounts set forth in section 1302(c)(1).
http://www.dol.gov/ebsa/faqs/faq-aca12.html
Comment:
By Don McCanne, M.D.
One of the most important benefits of Obamacare is the establishment of maximum out-of-pocket spending that any individual or family would have to face in any given year. Although the amounts will still be unduly burdensome for far too many, nevertheless, it does provide some protection against catastrophic loss.
For the first year, 2014, the administration is allowing maximums to apply separately to both major medical coverage and prescription drug coverage, so patients could face twice the maximum in out-of-pocket spending. This transitional relaxation of the rules is to allow insurers to coordinate their computers that currently administer medical benefits and drug coverage separately.
We’ve discussed before the fact that losses in excess of the maximums may still occur because of limitations in benefits covered or from services provided outside of health plan networks. This one year transition not only will add to that exposure, but it also provides yet another example of the excessive administrative complexity of Obamacare. Wasting resources on excessive administrative services while exposing patients to potential financial hardship would be greatly diminished by changing to a single payer national health program.