The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurance plans that have separate policies or different benefits managers for different parts of their coverage.
Under the policy, many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctors' services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager.
In Iowa, some health plan members of Wellmark Blue Cross and Blue Shield will keep the same out-of-pocket limits through the end of 2014, a company representative confirmed.
In June, Wellmark announced an offer to extend current health plan provisions for its under-65 individual members and small business groups through the end of 2014, with no increase in base rates.
"For a group who elects to extend their plan year, they will keep their current out-of- pocket for the bulk of 2014 or until they roll onto an (Affordable Care Act)-compliant plan," said Traci McBee, a Wellmark spokeswoman.
Current out-of-pocket maximums offered under Wellmark plans vary, with some being lower than the delayed limit and others being higher, McBee said. A group may elect to have a different limit, but it will need to be at or under the new maximum amount, she said.