Has anyone read much about the ACA's definition of Out-of-Pocket Max? I know that the dollar amount can vary greatly (from $500 to $6250, from what I've seen to-date.) But I'm interested in the definition. That is, what does or does not "count" towards the calculation of reaching your Max.
For example, premiums do not count. They didn't before the ACA, and they still won't. Also, services that the plan does not cover, like some elective surgeries, will not count. And, balance-billing for out-of-network providers will not count.
Here's where things may have changed: I believe that, under the new law, ACA-compliant plans have to include just about everything else in determing whether you've reached your OOPmax. That will now include: deductibles, co-insurance, and co-payments. In other words, you may reach your OOPmax much sooner than you would have in most pre-ACA policies, because they typically excluded these expenses.
The newly defined ACA OOPmax is sometimes referred to as a "true" OOPmax. Can anyone provide a sound reference or link to support (or debunk) my interpretation? Thanks!
For example, premiums do not count. They didn't before the ACA, and they still won't. Also, services that the plan does not cover, like some elective surgeries, will not count. And, balance-billing for out-of-network providers will not count.
Here's where things may have changed: I believe that, under the new law, ACA-compliant plans have to include just about everything else in determing whether you've reached your OOPmax. That will now include: deductibles, co-insurance, and co-payments. In other words, you may reach your OOPmax much sooner than you would have in most pre-ACA policies, because they typically excluded these expenses.
The newly defined ACA OOPmax is sometimes referred to as a "true" OOPmax. Can anyone provide a sound reference or link to support (or debunk) my interpretation? Thanks!