I know there’s a limit on annual out of pocket cost, but is there any restrictions on co payments? My company just increased ours significantly, and it seems to be their way of saving money to get around the new health insurance costs. I don’t go to the doctor nearly enough to hit the annual limit, but this is going to still be a huge strain on me financially next year. It seems to me like they found a loop hole to some of the rules by just increasing our out of pocket cost. I currently have the best plan they offer.


Answer

There aren't copayment restrictions, but plans must offer an actuarial value of at least 60%, which means they must pay on average 60% of all costs of all people on the plan.

There are restrictions on maximum deductibles and out-of-pocket maximums. This means coinsurance and copayments of covered benefits can be decreased or increased on a specific plan to meet the minimum actuarial value of the plan. Typically a bronze plan is at least 60% AV, silver 70%, gold 80%, and platinum 90%.

You can learn more about Actuarial Value (AV) here.

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Susan on

I’m going for a foot checkup. At family practice. Do I have a copy?

erin.georgen@gmail.com Erin on

It literally depends on what insurance you have. Call your insurer and ask them.

Collin LaMey on

That means under The ACA, I could taje a day off from work and get hit wirh say a $2500 bill. In the past, u could pay say $10 – $75 copay theb Rhe Insurance Company would pay the major bill. Under The ACA, The major bill is borne by the insured until rhe deductible is met. That’s good for the Insurer because mist individuals will not spend $7100 on hearhcare for the whole year abd yet ur payingva premium which does not count towards your oop expense. Most people will no go to the doctor because of that so rhe nations’ health is compromised.