The Obama administration is seeking to blunt the impact of New York Times report that says caps on out-of-pocket medical costs promised by the Affordable Care Act (ACA) in some cases won’t be available until 2015, or a year later than stated in the ACA.
The limits are a “still a major win” for consumers, according to an unnamed administration official interviewed by the newsletter CQ HealthBeat, even though the delay will apply in some cases to payments for prescription drugs. Republicans had seized on the story as evidence that the Obama administration again is cushioning big business from difficulties in complying with the health law, in line with the previous postponement of the employer mandate.
The Labor Department disclosed the delay in February, but called little attention to it in its press materials. It also escaped the notice of many lawmakers on Capitol Hill. The postponement was granted to some plans because employers and insurers said they needed more time to retool computer systems to comply with the new out-of-pocket limits.
Under the health law, plans in 2014 can’t require an enrollee to pay more than $6,350 annually, or $12,700 for families, for medical services and pharmaceuticals. The one-year delay applies to health plans that have different benefit administrators for medical services and for pharmaceuticals, the federal official said.
For example, plans that carve out their drug benefits and have them managed by a different vendor fall into this category. These plans must abide by the $6,350 limit on medical services in 2014, just as other health plans must. They also must have a limit of $6,350 in 2014 on drug expenses if they currently limit out-of-pocket drug expenditures. That means plans that split up their benefits administration can have double the ACA’s out-of-pocket limit in 2014.