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Good Neighbor Travel Insurance Blog

Annual Limitations on Cost-sharing is the out-of-pocket maximum

April 14, 2015 By : Doug Gulleson

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 info@gninsurance.com.  We are located in Gilbert, Arizona.

Doug Gulleson

Search Results

France – an epicurean’s delight

May 16, 2012

Whenever you are France you will want to make sure you have international medical coverage primarily to provide you peace of mind just in case tragedy strikes. Good Neighbor Insurance, www.gninsurance.com, has been involved in providing international health care cover to our clients since 1997.  Not only is the Good Neighbor Insurance team knowledgeable in […]

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Love and Romance is Alive on a Bridge

June 8, 2015

Love and romance is alive on a bridge in the world’s most romantic city of Paris, France. As well as the Eiffel Tower the Pont des Arts Bridge is also a famous romantic spot. Pont des Arts Bridge is a steel and wooden bridge, 155 meters long and 11 meters wide. This bridge was built […]

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Affordable Care Act (ACA) Violations as well as Penalties and Excise Taxes

June 1, 2015

Affordable Care Act (ACA) Violations as well as Penalties and Excise Taxes. The Affordable Care Act (ACA) includes numerous reforms for group health plans and creates new compliance obligations for employers and health plan sponsors. The ACA, for example, requires health plans to eliminate pre-existing condition exclusions and provide coverage for preventive care services without cost-sharing. Some […]

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Pediatric Dental Coverage on U.S. domestic group insurance policies

February 11, 2014

Unfortunately, with the new requirements per the Affordable Care Act in 2014, carriers are mandated to have pediatric dental benefits included in the medical plan.  Employers have no choice to “opt out”, even if they do not have any families/dependents, as the law requires the benefit be in place. With many major medical carriers, these […]

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Phoenix Brain Tumor Walk – This Saturday, March 15th, 2014

March 12, 2014

One of our GNI (Good Neighbor Insurance) family members, Sandy and Richard have asked us to share with our guests, you all, of a great walk they are involved with. Below is information on how to be a part of this great cause. Thank you, Sandy and Richard, for your dedication in helping us Americans […]

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Expatriate medical insurance and overseas travel insurance for those with U.S. Medicare – Part 3.

February 28, 2018

Expatriate medical insurance and overseas travel insurance for those with U.S. Medicare– Part 3.  This is the last part of our three-part series discussing U.S. Medicare and international medical travel and expatriate medical insurance.  For those who are expatriates / expats (for us at Good Neighbor Insurance we call expats who live outside their native / […]

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