Historic Consumer Protections Take Effect, On Time

Landmark consumer protections, including limits on out-of pocket costs in health insurance plans, are taking effect next year, on time. Here are the facts:

Under the Affordable Care Act, for the first time, new historic consumer protections will stop the worst insurance company abuses, by making it illegal for companies to discriminate based on pre-existing health conditions, ending lifetime and annual dollar limits on what an insurance company will cover, and capping out-of pocket spending to protect Americans and their families.

For the first time, under the Affordable Care Act, consumers’ out-of-pocket costs will be limited to no more than $6,350 per individual, and $12,700 per family, to help protect people with serious illness from financial ruin.  Until now, consumers with insurance still faced unlimited out-of-pocket costs for medical care and prescription drugs - which could wreak financial havoc in the midst of a serious illness or health crisis .

In February, the Administration put out public guidance to implement this important consumer protection, on time. 

Here’s how it will work for you and your family: If you are buying a plan on the new Health Insurance Marketplace, your out-of-pocket limit in 2014 for medical and drug costs combined will not exceed $6,350.

If you already have insurance through your employer, your out-of-pocket limit for major medical costs will also not exceed $6,350.

But the February guidance recognized that some employer plans use separate benefit administrators for their insurance coverage (for instance one for major medical coverage and another for drug coverage). Tech systems cannot communicate with one another yet, so the guidance allowed these existing plans to separately limit out of pocket spending on major medical expenses, and drug plans that currently have out-of-pocket limits. By 2015, Americans in these plans will have one, single maximum out-of-pocket limit of $6,350 for combined medical and drug costs, just like in the Marketplaces.

Consumers will have historic new protections that improve your coverage and help provide peace of mind so that if you do get sick, you can start focusing on getting better, instead of worrying about going bankrupt.

Jeanne Lambrew, Deputy Assistant to the President for Health Policy.
Related Topics: Health Care
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