CMS Will Enforce Rule on Individual Out-of-Pocket Spending Caps

On Tuesday, CMS said it will enforce the Affordable Care Act’s cap on annual out-of-pocket health care spending for individuals, regardless of whether consumers have an individual or family health plan, Modern Healthcare reports.

Background

In February, CMS released a wide-ranging final rule for the health insurance exchanges that finalized several consumer and insurer protections. Among other provisions, the rule capped maximum out-of-pocket costs at $6,850 for individual plans and $13,700 for family plans annually.

A Department of Labor document released in May clarified the policy, noting that even if a family health plan has a combined out-of-pocket cost limit of $13,700, no one individual on the plan can be liable for more than $6,850 in annual out-of-pocket costs.

According to Modern Healthcare, large employers have strongly opposed the cap on out-of-pocket spending, noting that they or the insurer are responsible for any additional costs.

The ERISA Industry Committee, a lobbying group that represents large companies, in a poll of its members found that about 70% of respondents would be “moderately or significantly affected” by such caps. ERISA Industry Committee CEO Annette Guarisco in a letter to the House Committee on Energy and Commerce wrote, “Some of our members will be forced to spend millions of dollars to make this change.”

CMS Will Enforce Cost Limits

HealthCare.gov CEO Kevin Counihan in a letter sent to employers said CMS will enforce the new cost caps. He wrote, “We believe that applying the individual $6,850 maximum … helps remedy the difficulty a consumer could face in paying up to $13,700 out-of-pocket for certain covered medical care under the plan because he or she purchased family coverage instead of self-only coverage”

Source Link

Recommended Articles

White House Leaves One Trump-Era Policy Alone

The Biden administration has gutted many of former President Donald Trump’s health care policies, but there’s one that the White House has yet to touch, Kelly reports. It’s a 2019 rule that expanded individual coverage health reimbursement arrangements, or ICHRAs, which allowed employers to provide tax-exempt subsidies to help workers purchase Obamacare plans. The Biden administration’s ...

Read More

Court Strikes Down HHS Rule that Allowed Insurers to Not Count Copay Assistance

In a major victory for patients who depend on prescription drugs, Judge John D. Bates of the U.S. District Court for the District of Columbia struck down a Trump administration federal rule that allowed health insurers to not count drug manufacturer copay assistance towards a beneficiary’s out-of-pocket costs. The case was brought against the U.S. Department of Health and ...

Read More

Lawmakers, Payers And Providers All Air Grievances With Federal No Surprises Act Implementation

Amid a flurry of partisan roadblocks rolling out across Capitol Hill, representatives on both sides of the aisle came together Tuesday to critique federal agencies’ rollout of the No Surprises Act and throw their support behind court-ordered rewrites of independent dispute resolution (IDR) regulations. During a hearing exploring the “flawed implementation” of the law intended ...

Read More

As Biden Plans To Ban Medical Debt From Credit Scores, Advocates Press For More Change

The dramatic impact of medical debt on credit scores may soon be a thing of the past. On Thursday, the White House announced a plan outlined by the Consumer Financial Protection Bureau (CFPB) to eliminate medical debt from credit reports. The move — which follows an earlier decision from the three main credit bureaus to eliminate paid medical debt, medical ...

Read More
arrowcaret-downclosefacebook-squarehamburgerinstagram-squarelinkedin-squarepauseplaytwitter-squareyoutube-square