It’s almost that time of year when insurance companies start sending out information about next year’s plans and what may or may not have changed in their policies, such as premiums and benefits.
A little-known new rule of the Affordable Care Act (ACA) will take effect on January 1, 2016, and might affect your health insurance plan and health care costs.
Specifically, this rule takes away what’s been called the “umbrella limit” on out-of-pocket maximums for families.
If you currently have a family policy with a family out-of-pocket maximum (up to $13,200 in 2015), even if only one family member gets injured or ill, you must meet that entire out-of-pocket limit before your insurance company begins paying in full. Even though, per the ACA, an individual’s out-of-pocket maximum is only $6,600.
For example, a few years ago my husband had thyroid surgery and altogether his costs easily met (and surpassed!) our then family out-of-pocket maximum of $10,000, but according to our insurance company our individual out-of-pocket limit was only $5,000.
I never really understood this practice—why even mention an individual out-of-pocket maximum when it will never apply in a family situation?
Now it will make more sense. Starting on January 1 next year, all ACA-compliant health plans must apply a “self-only” out-of-pocket limit for each family member.
Of course, the maximums will be higher next year: $6,850 for individuals and $13,700 for families. That’s still pretty darn costly.
However, the new rule could help reduce a family’s health expenses, especially in the case where only one family member needs a lot of health care. A family could save several thousand dollars.
I noticed last year that some insurance companies had already started applying the self-only deductibles and out-of-pocket maximums.
And some insurance plans, mostly the more expensive gold and platinum plans or employer-provided plans, have much lower deductibles and out-of-pocket limits anyway.
The more affordable plans, such as the bronze and silver plans, and the high-deductible health savings account (HSA) plans, tend to have the lowest premiums but the highest deductibles and out-of-pocket maximums.
I will be interested to see how insurance companies (mine especially) restructure their plans to compensate for this new rule. After all, they will have to pay out more money, sooner, in many cases.
I know my premiums are set to go up by about %10.
I will be sure to read the fine print about deductibles and out-of-pocket maximums when the new policy information arrives next month.
Be informed on health insurance!