Out Of Pocket Maximum Increases due to Obamacare Mandates


Effective 1/1/2014, Obamacare mandates that all copays accumulate toward Out Of Pocket Maximums (OOP Max). Prior to Obamacare, anything that was deemed to be a copay, items such as office visits, emergency room visits, and prescription drug benefits, would not accumulate toward OOP Max. If you have a $20.00 office visit, $250 Emergency room Copay, or a $35.00 copay for a formulary drug, those costs would be charged to the subscriber the first time, as well as every other time during the plan year.

A copay is a per incident fee, which has never accumulated toward deductibles or OOP Maxs.

Out of Pocket Maximum (OOP MAX) has traditionally been the total of all deductibles, and coinsurance amounts.

Now, under Obamacare, it is mandated that these copays accumulate toward OOP Max. In theory, the consumer wins since he will reach his maximums more quickly, then after that ALL CHARGES, including Copays…

View original post 176 more words


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s