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More Affordable Care Act (ACA) delays: out-of-pocket health care expenses cap

On Monday, Aug. 12, 2013 The New York Times reported, “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.”

This is actually not a new delay, as the Department of Labor made this detail known on its FAQ page in February. However, the details of this delay are hard to find and understand in the way they are presented.

So what does it mean?

healthcareThe limits are the limits – $6,350 for an individual and $12,700 for a family – except when they are not. Plans with medical and drug benefits administered by the same entity will adhere to these limits. Participants in plans where medical and drug benefits are not handled by the same entity could face $6,350/single or $12,700/family for medical, and then another $6,350/single or $12,700/family for prescription drugs. And worse, drug plans that currently have no cap on out-of-pocket expenses will continue to not cap expenses until 2015.

ABC News reported, “The one-year grace period for compliance of some plans will allow insurers more time to finalize computer systems to track their beneficiaries’ spending in order to comply with the law, officials and industry representatives said.” And, “President Obama has acknowledged the rocky road but insists everything is going according to plan. ‘This is a big country, and the health care industry is massive and there are tons of providers. And so as we implement, there are going to be glitches,’ he said last month. ‘And we’re just steadily working through all that stuff.’”

Delays and all, the countdown is on. All states must have their exchanges up and running by October 1, 2013. Employers must notify employees about the exchanges by October 1, 2013. And, January 1, 2014, ACA will be in full effect. To see details about how ACA will change health care in your state, you can check out the website set up by the Obama administration.


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