Obamacare Limit on Consumer Costs To Be Delayed a Year
Tuesday, 13 Aug 2013 09:29 AM
The implementation of Obamacare is suffering another setback, after it was discovered that a rule establishing a maximum limit in the out-of-pocket expenses people may have to spend on their own health care will be delayed until 2015.
The health care law stipulates that individuals will not have to spend more than $6,350 per year on their own, including deductibles and co-payments, while families would not spend more than $12,700.
But a little noticed rule in the legislation grants a one-year grace period to some insurers, allowing them to set higher limits or no limits at all on some costs in 2014, The New York Times reports.
The clause was established on the premise that insurers and employers may need more time to streamline the way they administer coverage and upgrade their computer systems to centrally keep track of individual out-of-pocket expenditures.
"We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which 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," an unnamed senior administration official told the Times.
The delay is bad news particularly for people with chronic illnesses, including cancer and disabilities, many whom have tens of thousands of dollars a year in out-of-pocket expenses for treatment and medications.
The news represents the second significant delay in the roll-out of the president's signature health care plan. In July, the administration announced it will not require employers to provide health insurance for their workers until 2015, prompting a wave a criticism about the viability of the law and the renewal of calls to repeal the program.
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Fact-checking…
ReplyDelete"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:
The plan complies with the requirements with respect to its major medical coverage (excluding, for example, prescription drug coverage and pediatric dental coverage); and
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).
The Departments note, however, that existing regulations implementing Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)[4] prohibit a group health plan (or health insurance coverage offered in connection with a group health plan) from applying a cumulative financial requirement or treatment limitation, such as an out-of-pocket maximum, to mental health or substance use disorder benefits that accumulates separately from any such cumulative financial requirement or treatment limitation established for medical/surgical benefits. Accordingly, under MHPAEA, plans and issuers are prohibited from imposing an annual out-of-pocket maximum on all medical/surgical benefits and a separate annual out-of-pocket maximum on all mental health and substance use disorder benefits."
http://www.dol.gov/ebsa/faqs/faq-aca12.html
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Your article does not acknowledge any of these restrictions and limitations that WILL apply to insurance companies in 2014. Prior to Obamacare, none of these rules existed, and from 2015 and thereafter the caps will all be working once the affected insurance companies get their computer systems modified.
These are all major consumer cost savings that would vanish without Obamacare.
--David