Affordable Cap Will Stay in Washington Health Plans

By Steve Jackson

Information that an affordable cap on out of pocket expenses is being delayed for individuals who will be covered under the Affordable Care Act will not have an impact on most Washingtonians. A key provision touted in the ACA is a cap for individuals of $6,000 dollars a year for out of pocket expenses. Proponents have said this cap will reduce, if not eliminate, cases of people who lose everything they have from exorbitant medical costs.

But earlier this week, the New York Times reported the Obama administration was holding off on instituting that out of pocket expense limit.
The reason, health care providers say their computer systems aren’t set up to determine all those costs.

But in Washington State, it appears the cap will remain in place. Insurance Commissioner Mike Kriedler says some large employers that are self insured do have some IT issues related to determining actual prescription versus medical treatment claims. But he says all the individual and family coverage through the new Health insurance exchange in the state will have an affordable out of pocket cap.

Kriedler: “The good new for Washingtonians for the individual and small group market in Washington, it doesn’t have any impact. The only impact would be in the self insured plans, but many of them tend to be pretty comprehensive plans with low deductibles, and so it would have little or no impact on them.”

Kreidler says his agency reviewed all of the 31 health plans approved for the state, and all of them agreed to a six thousand dollar cap for an individual plan per year, and for family plans the cap would be 12 thousand dollars out of pocket per year.

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