ACA cap on out-of-pocket maximums delayed to 2015

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ACA cap on out-of-pocket maximums delayed to 2015
ACA cap on out-of-pocket maximums delayed to 2015

A recent announcement by the Obama administration revealed that caps on consumer spending for out-of-pocket medical expenses – a major part of the healthcare reform initiative - will be put on hold until 2015.

The move – which was announced in February 2013 but gained notice when The New York Times reported on it on Aug. 14 – means that Americans will need to wait an additional year to take advantage of one of the most essential consumer protections outlined in the Patient Protection and Affordable Care Act, which was the first-ever attempt to limit personal spending for medical care.

Under the ACA, health plans' out-of-pocket limits for medical care and prescription drugs for individuals cannot exceed $6,350 a year. For families, this figure can't go beyond $12,700 annually, and this includes co-payments and deductibles, The New York Times reported.

"For people with complex chronic conditions, this decision contradicts the out-of-pocket provisions the patient community fought for in the ACA," Nancy Hughes of the National Health Council, a patient advocacy group, told ABC News. "It will be a major financial burden that will most certainly impact patient access to quality health care."

The benefits of consumer-directed healthcare plans
Changes to traditional insurance models stemming from healthcare reform make it imperative for employers to explore new options for employee medical coverage.

Consumer-directed healthcare plans are increasingly becoming a more attractive option to employers and workers alike because they provide individuals with a convenient and flexible way to balance medical spending and have comprehensive coverage.

Employers may be on the fence about whether to offer health savings accounts (HSAs) or health reimbursement arrangements (HRAs), and also how to make employer-sponsored benefit plans appealing to employees, especially those who are young.

A recent study by the ADP Research Institute found that just half of employees under age 30 who were eligible for employer health benefits chose to enroll in plans, compared to 70 percent of employees aged 40 or older.

To encourage younger workers to experience the benefits of these plans, researchers urged taking a more proactive approach.

"Engage all employees to adopt and sustain a healthy lifestyle, and become intelligent consumers of healthcare early on and offer a consumer-directed health plan alternative that provides young people with an option to enroll in coverage with the lowest premium outlay relative to income," Christopher Ryan, vice president of strategic advisory services at ADP Research Institute, told Human Resource Executive Online.

Consumer-directed healthcare plans offer the variety and flexibility that young people are searching for in medical coverage, yet can also be beneficial for helping them develop better skills for managing their healthcare needs.

*Note: Content provided is not intended as legal or tax advice.