What Is The Out of Pocket Maximum You Will Pay Under the PPACA?

There are quite a few blogs in the blogosphere who tend to get the PPACA wrong and conflate the issues of it well beyond what is reasonable and truthful. Maybe they just do not know what the facts are and miss the benefits of the PPACA to dwell on the negatives exclusively. Many tend to dwell on the amount of money one has to pay out in insurance and deductibles, what the PPACA does not do, and why we should go back to . . . ahh nothing? For the record, the PPACA is not single payer nor is it even universal healthcare. It is a convenient compromise which has many positives which did not exist previously. Some thoughts for those who think differently . . .

Maggie Mahar at The Health Beat Blog: “Even if you do not qualify for a subsidy, your out of pocket spending is capped at about $5,500 for an individual; $12,000 for a couple. (That includes deductible and co-pays under a Bronze plan–or any other plan)

A couple earning $65,000 joint might not have $12,000 lying around –especially if they were young. But they could work out a payment plan with the hospital or surgeon– paying, say $5,000 up front as a sign of good faith, and $7,000 over time. If they had to, they could borrow the $5,000 from relatives or friends or a credit card.(These days it’s pretty easy to get a credit card that charges 0% interests on cash withdrawals for 6 months to a year.)

Bottom line: they don’t lose their house, and they don’t go bankrupt. A $12,000 bill is the worst that can happen to them, even if they’re in a horrible accident and in the hospital for 3 months.

There will also be no annual limit or lifetime limit on how much the policy will pay out. This is why the ACA is a boon—even for people who don’t qualify for subsidies. You can’t be ruined by medical bills, and they can stop paying even if you have a very expensive chronic disease.

As for poor people –if they’re below 133% of poverty, they’ll be on Medicaid (once all of the states expand Medicaid which, eventually, they will). If they’re above 133% of poverty, the subsidies are rich enough to make insurance comprehensive affordable.” Maggie Mahar in an email to me.

Families USA Foundation: Worry Less, Spend Less: Out-of-Pocket Spending Caps Protect America’s Families; “The Affordable Care Act initially sets the level of these new caps by referencing an existing definition—the annual out-of-pocket spending limits for high-deductible health plans that are associated with Health Savings Accounts (HSAs). If these caps went into effect in 2011,they would be $5,950 for individuals and $11,900 for families.” http://www.familiesusa2.org/assets/pdfs/health-reform/out-of-pocket-spending-caps/National-Report.pdf “Worry Less, Spend Less: Out-of-Pocket Spending Caps Protect America’s Families”

Granted, I am not a big fan of Barack Obama who wanders down the double yellow, weaving from one side to the other in attempting to secure his place in presidential history; but in the end, we are better off with the PPAC than what we had before “nothing.”

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One Response to “What Is The Out of Pocket Maximum You Will Pay Under the PPACA?”

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  1. EricRhoades says:

    This whole thing is starting to turn into the best argument for a single payer system. There is a good chance it will turn into a political albatross for Democrats also. Normally programs like this are initially unpopular but become entrenched when enough people come to depend upon their benefits, I tend to think though that in an age of high unemployment the jobs effect is likely to get a lot more traction than the people helped who had pre-existing conditions. In that light one of the things this is highlighting is the amount of what have to be termed low standard jobs that people hold, how many people their are out there without employer supplied health care. One of the most troubling trends I have heard of is the move to change people to part-time to avoid the requirement of supplying health coverage based on payrolls, this is driving people low on the employment ladder further down.

    How I wish we had a functioning government rather than one that creates these half assed patchwork programs, laws, and regulations. Life could be so much better for just a little honest effort.

What do you think?