Wednesday, August 14, 2013

ACA Out of Pocket Change

Yesterday there was an announcement that the Affordable Care Act was going to hold off the implementation of the out of pocket limits. This hit the news wires and the sparks really flew. I have spent a lot of time today to find out exactly what was happening and find it is not the big deal it appeared to be. First it did not apply to individual policies and second I have found it will not apply to the Small Business Health Option Plan in California[SHOP].

Please see email from Micah  at the Bay Area Council along with a link to New Republic.
The second email is from Leesa Tori at Covered California confirming it will have no impact on SHOP. My guess is that will also have little to no effect outside Covered California. What is interesting is this announcement was originally made in February and very few people knew about it until  yesterday.

Scott Hauge
Small Business California
2311 Taraval Street
San Francisco, CA  94116


Scott,Looking into this further, I’m not sure that it’s even applicable.  Here’s a good summary.  This is much more limited than it’s being made out to be in the press and I’m not sure it would even potentially apply to the SHOP.

“Employers told the administration that coordinating records from the different plans was difficult, so the administration gave them some leeway. Employers who already have such arrangements—and only employers who already have such arrangements—can have one extra year to put new accounting systems in place. During that time, the $6,350 limit will apply to “major medical”—doctor visits, hospitalizations, and so on—but not prescriptions, dental, or vision.” 


Micah Weinberg, PhD | Senior Policy Advisor | BAYAREA COUNCIL
1215 K Street, Suite 2220 | Sacramento, CA 95814
916-949-6240 (c) 916-706-1277 (o) |


From: Leesa Tori []
Sent: Wednesday, August 14, 2013 11:32 AM
To: Scott Hauge
Subject: Re: SHOP

Hi Scott, we do not intend to change our benefit designs and  I think it’s business as usual for us with no change.  Hope you are well!  Thank you.  L.

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