How to Stay In Business

[medx]

I'm not sure where you're getting your info from, but according to the legislation, the family OOP can be $10,000.

Can you reference the part of the legislation limiting the family OOP to $2,500? Not an article - but the actual PDF file of the legislation?

Sure:

Set a maximum of $2000 annual deductible for a plan covering a single individual or $4000 annual deductible for any other plan (see 111HR3590ENR, section 1302).
" $2,500 limit on tax-free contributions on tax-free contributions to flexible spending accounts "

Patient Protection And Affordable Care Act Information, Patient Protection And Affordable Care Act Reference Articles - FindTarget Reference

and

http://democrats.senate.gov/reform/patient-protection-affordable-care-act-as-passed.pdf

 

[Crabcake Johnny]

I'm not talking about contributions - you said this regarding plan OOP's:'


"The new Mandates requires plans have a max out of pocket of 2500 a year (Deductible, co-pays, and co- insurance combined) and almost all HSA's do not meet the particularly mandate, and will result in a penalty"


This is incorrect.

 

[VolAgent]

Sure:

" $2,500 limit on tax-free contributions on tax-free contributions to flexible spending accounts "

Patient Protection And Affordable Care Act Information, Patient Protection And Affordable Care Act Reference Articles - FindTarget Reference

and

http://democrats.senate.gov/reform/patient-protection-affordable-care-act-as-passed.pdf

Just in case you were not clear on this, Health FSA does not equal HSA. They are two totally different things.

 

[CHUMPS FROM OXFORD]

I'm starting to feel a bit better now.

 

[medx]

I'm not talking about contributions - you said this regarding plan OOP's:'


"The new Mandates requires plans have a max out of pocket of 2500 a year (Deductible, co-pays, and co- insurance combined) and almost all HSA's do not meet the particularly mandate, and will result in a penalty"


This is incorrect.

Please read again:

"Set a maximum of $2000 annual deductible for a plan covering a single individual or $4000 annual deductible" for any other plan (see 111HR3590ENR, section 1302).
thiss includes HSA's

and from :
Congress Declares War on HSAs | Publications | National Center for Policy Analysis | NCPA
The Senate Bill Favors Premiums Over Savings. HSA health plans are insurance plans that allow an individual and/or his employer to deposit funds into a special savings account. The funds are not subject to the income tax if withdrawals are used to pay out-of-pocket medical expenses. Right now, HSA plans are the only form of health insurance under which an individual's out-of-pocket exposure is limited by law. Currently, the limits are $5,950 for individuals and $11,900 for families. A plan could have lower deductibles and require patient copays up the total limit, or it could have deductibles as high as $5,950/$11,900 so long as the plan pays all costs above those amounts.

However, the Senate bill limits the deductible for small group plans to $2,000 for singles and $4,000 for families - roughly one-third the level allowed under current HSA law - with copays above the deductible. Many people would choose a $5,950 deducible over a $2,000 deductible and place the premium savings in an HSA. But this is a choice the Senate bill would deny them.

 

[Crabcake Johnny]

That would be true...for employer sponsored plan. And yes, for those plans it's a $4,000 deductible for families. How does that fit in with your previous post that plans must have an OOP of $2,500? Where did you come up with a $2,500 OOP?

Now...you're almost ready to find the rules for individual coverage.

 

[medx]

That would be true...for employer sponsored plan. And yes, for those plans it's a $4,000 deductible for families. How does that fit in with your previous post that plans must have an OOP of $2,500? Where did you come up with a $2,500 OOP?

Now...you're almost ready to find the rules for individual coverage.

The 2000 for singles, and 4000 for families applies to all plans, including HSA's

 

[Crabcake Johnny]

....for employer sponsored plans...yes. Where again did you get $2,500 OOP?

 

[medx]

....for employer sponsored plans...yes. Where again did you get $2,500 OOP?

Once again, The 2000 for singles, and 4000 for families applies to all plans, not just employer sponsored plans.


Effective by January 1, 2014

• Insurers are prohibited from discriminating against or charging higher rates for any individuals based on pre-existing medical conditions.

• Insurers are prohibited from establishing annual spending caps.

• Expand Medicaid eligibility; individuals with income up to 133% of the poverty line qualify for coverage, including adults without dependent children.

• Two years of tax credits will be offered to qualified small businesses. In order to receive the full benefit of a 50% premium subsidy, the small business must have an average payroll per full time equivalent("FTE")employee, excluding the owner of the business, of less than $25,000 and have fewer than 11 FTEs. The subsidy is reduced by 6.7% per additional employee and 4% per additional $1,000 of average compensation. A 16 FTE firm with a $35,000 average salary would be entitled to a 10% premium subsidy.

• Impose a $2000 per employee tax penalty on employers with more than 50 employees who do not offer health insurance to their full-time workers (as amended by the reconciliation bill).Kristen McNamara, , Wall Street Journal (25 March 2010). (In 2008, more than 95% of employers with at least 50 employees offered health insurance., Kaiser Family Foundation.)

• Set a maximum of $2000 annual deductible for a plan covering a single individual or $4000 annual deductible for any other plan (see 111HR3590ENR, section 1302). These limits can be increased under rules set in section 1302.

Impose an annual penalty of $95, or up to 1% of income, whichever is greater, on individuals who do not secure insurance; this will rise to $695, or 2.5% of income, by 2016. This is an individual limit; families have a limit of $2,085. Exemptions to the fine in cases of financial hardship or religious beliefs are permitted.

• Under the CLASS Act provision, creates a new voluntary long-term care insurance program; enrollees who have paid premiums into the program and become eligible (due to disability or chronic illnesses) would receive benefits that help pay for assistance in the home or in a facility., The Daily Item, Sunbury PA (March 26, 2010).

• Employed individuals who pay more than 9.5% of their income on health insurance premiums will be permitted to purchase insurance policies from a state-controlled health insurance option.

• Pay for new spending, in part, through spending and coverage cuts in Medicare Advantage, slowing the growth of Medicare provider payments (in part through the creation of a new Independent Payment Advisory Board), reducing Medicare and Medicaid drug reimbursement rate, cutting other Medicare and Medicaid spending.

• Revenue increases from a new $2,500 limit on tax-free contributions to flexible spending accounts (FSAs), which allow for payment of health costs.

• Chain restaurants and food vendors with 20 or more locations are required to display the caloric content of their foods on menus, drive-through menus, and vending machines. Additional information, such as saturated fat, carbohydrate, and sodium content, must also be made available upon request.

Establish health insurance exchanges, and subsidization of insurance premiums for individuals with income up to 400% of the poverty line, as well as single adults. Section 1401(36B) of PPACA explains that the subsidy will be provided as a advanceable, refundable tax credit and gives a formula for its calculation.Patient Protection and Affordable Care Act: Title I: Subtitle E: Part I: Subpart A: Premium Calculation Refundable tax credit is a way to provide government benefit to people even with no tax liability (example: Child Tax Credit). According to White House and Congressional Budget Office estimates, in 2016 the income-based premium caps for a "silver" healthcare plan for family of four would be the following:

 

[Crabcake Johnny]

It's nice that you found Wikipedia and admittedly, this is very difficult information to come across since it literally entails reading the entire bill - a daunting task at over 2,000 pages.

First of all, the bill addresses deductibles as well as OOPs which related articles don't address.

They also don't address the difference between individual and family coverage - and they are difference in the legislation.

And now it even gets much harder. There was the House version, the Senate version then reconciliation. Pulling up the reconciliation version is hard reading this is reference mainly changes in the House and Senate version.

But here are the deductible the OOP limits for individual coverage: (so Wikipedia is correct...they simply didn't elaborate on the OOP for individual plans.)

(2) COVERED BENEFITS.

1 Secretary and shall be consistent with the basic categories in the essential benefits package described in section 222. Under such benefits package—4 (A) the annual deductible for such benefits may not be higher than $2,000 for an individual or such higher amount for a family as determined by the Secretary; (B) there may not be annual or lifetime limits; and (C) the maximum cost-sharing with respect to an individual (or family) for a year shall not exceed $5,000 for an individual (or $10,000 for a family).
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