Thread: Obama Care
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Old 10-31-2013, 06:31 PM
Hopeless Hopeless is offline
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Hopeless Hopeless is offline
Senior Member
 
Join Date: Jun 2013
Location: USA
Posts: 1,232
10 yr Member
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Quote:
Originally Posted by Kim12 View Post
The ACA plans have caps on out of pocket expenses so that people won't get wiped out. I believe the cap for an individual is around $6500 and for a family it's around $12,500.

Copied and pasted from Healthcare.gov

The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges, or health care your health insurance or plan doesn’t cover. Some health insurance or plans don’t count your copayments, deductibles, coinsurance payments, out-of-network payments, or other expenses toward this limit. In Medicaid and CHIP, the limit includes premiums. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan

Please note the line that reads: Some health insurance or plans don’t count your copayments, deductibles, coinsurance payments, out-of-network payments, or other expenses toward this limit.

Sounds to me that the 40% co-insurance on a bronze plan may NOT be part of the cap on "out of pocket" expenses. Maybe it is---- maybe it is NOT ???

I would want confirmation that I would NEVER be paying out of MY pocket more than $6350 per year (plus my premium amounts) before I would sign up for such an ambiguous statement.

Other terminology to be wary of includes "allowed amount". Example: Your doc charges $125, your plan pays 100% of the "allowed amount" of $75. You are left to pay the $50 and it may not go toward your "out of pocket" expenses?
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