Healthcare Issues

Confused About 2014 Maximum-Out-of-Pocket Costs?

ACA Prescribed Limits Are Still on Track for Most Plans in 2014

Out-of-Pocket (OOP) maximums of $6,350 for individuals and $12,700 for families will still apply for most customary fully-insured health insurance plans in 2014 (coinciding with renewal/anniversary dates; new plan year effective dates). Many publications and other news sources have created some confusion by reporting that the Affordable Care Act provision limiting maximum out of pocket costs has been delayed until 2015. The delay only impacts those plans that carve out certain benefits (e.g. pharmacy, mental health benefits) for administration by separate third-party providers.  In those cases, a health plan’s medical benefits and its carved out benefit(s) may apply toward separate out-of-pocket maximums in 2014.  This appears to be a one year exception for carve-outs and all plans are expected to aggregate out-of-pocket maximums beginning in 2015.

Employer Sponsored Coverage – Just the Facts

We’re often asked by clients and colleagues about how their health coverage (and related costs) stacks up against the averages. Kaiser Family Foundation (KFF) recently released the results of their Annual Employer Health Benefits Survey. Among the findings:

  • Employer-sponsored insurance covers about 149 million nonelderly people.
  • In 2013, the average annual premiums for employer-sponsored health insurance are $5,884 for single coverage and $16,351 for family coverage.
  • There is significant variation around the average single and family premiums, resulting from differences in benefits, cost sharing, covered populations, and geographical location.
  • 21% of covered workers are in plans with an annual total premium for family coverage of at least $19,622 (120% of the average family premium).
  • 21% of covered workers are in plans where the family premium is less than $13,081 (80% of the average family premium).
  • Over the last 10 years, the average premium for family coverage has increased 80%.
  • 57% of firms offer health benefits to their workers.
  • 45% of employers with 3 to 9 workers offer coverage, but virtually all employers with 1,000 or more workers offer coverage to at least some of their employees.

The complete results and analysis of KFF’s Employer Health Benefit Survey can be found at http://kff.org/private-insurance/report/2013-employer-health-benefits/

Brooks on Healthcare Reform: Years of Chaos and Scrambling Before an Eventual New Normal.

Health Care Reform continues to create anxiety and unsteadiness due to the lack of clarity and the still many unresolved issues. With the major provisions of the Affordable Care Act (ACA) slated to hit in 2014 columnists, commentators and reporters in the popular media are more closely tuning in and are beginning to recognize and comment on the potential for rough waters ahead.

To that end we think it’s worth calling attention to a recent column by David Brooks (New York Times, April 2013) in case you missed it. We think it’s a balanced appraisal and does a good job of discussing the major issues and fears associated with the implementation of ACA.  Brooks’ assessment leans towards being ultimately optimistic.  His reporting on the challenges and problems align with what we are finding in the trenches.  His column is to the point and definitely worth a read.

Our major concerns remain that many details on plans, rates and implementation are still unknown and the unintended consequences that could ensue.  While the law knocks down barriers to obtaining coverage, it seems to do little in terms of addressing costs and bending the cost curve.

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