Annual Limitations on Cost-sharing is the out-of-pocket maximum one pays per calendar year. This means that you, the policy holder, will know exactly what my “worse case out of pocket” will be for medical expenses under your current medical insurance policy. What do you mean, Doug? Well, no matter how you “slice and dice” it, you copays, deductible, and coinsurance will only come out to the maximum out of your wallet of what the out-of-pocket maximum you choose. So if you choose for the 2015 policy year a $4,500 out-of-pocket (OOP) maximum then that is all you will pay for your medical care for that policy year. If you had a no copay plan that had an OOP of $6,300 this means you would only pay OOP maximum of $6,300.
Below is information on OOP maximum for 2015 and 2016 calendar years. Effective for plan years beginning on or after Jan. 1, 2014, the ACA requires non-grandfathered health plans to comply with an overall annual limit, or an out-of-pocket maximum, on essential health benefits.
The ACA requires that the out-of-pocket maximum be updated annually based on the percent increase in average premiums per person for health insurance coverage.
- For 2015 calendar year: The out-of-pocket maximum is $6,600 for self-only coverage and $13,200 for family coverage.
- For 2016 calendar year: Under the proposed rule, the out-of-pocket maximum would increase for 2016 to $6,850 for self-only coverage and $13,700 for family coverage.
HHS also clarifies in the proposed rule that the out-of-pocket maximum applies for the plan year and not the calendar year for non-calendar year plans. Also, plans and issuers are permitted, but not required, to count out-of-network cost-sharing against the annual out-of-pocket maximum.
Good Neighbor Insurance provides Arizona medical insurance as well as international travel insurance to our clients since we started back in April 1997. Call one of our agents for ACA (affordable care act) Arizona medical insurance here at 480-633-9500 or email us at email@example.com. We are located in Gilbert, Arizona.