Reply #15: I think your figures up-thread are wrong... [View All]

[Iowa]

"There are max out of pocket expenses in the HC bill. I believe it's $2,000 for individuals and $4,000 for a family. If the bill passes, that will prevent the threat of high deductibles and co/pays." and then you go on to quote this: "...prohibits deductibles that are greater than $2,000 for individuals and $4,000 for families."

Someone please correct me if I'm wrong, but this doesn't appear to be correct. "Deductible" is not the same thing as "out-of-pocket maximum". Deductibles are what you pay before the insurance company pays anything. Then co-insurance kicks in - for example, you might continue to pay 20% of costs after the deductible is met. And there are also "co-pays" which are another thing entirely.

From your post, it appears that this is the line that addresses out-of-pocket maximums:

"For all plans in all markets, prohibits out-of-pocket limits that are greater than the limits for Health Savings Accounts."

I did a brief search for 2010 out-of-pocket maximums for HSAs. I don't have a Health Savings Account, so there may be wrinkles I don't understand. Nevertheless, I checked several sources and they were all the same. I'll include this URL simply because it isn't a mile long:

http://www.hsacenter.com/2010-HSA-Contribution-Limits.php

Here's the bottom line:

Individual Out-of-Pocket Maximum: $5950
Family Out-of-Pocket Maximum: $11,900

And they go up every year. And on top of that you must pay the premium. Furthermore, in many plans today co-pays do NOT count toward out-of-pocket maximums. So it's possible the actual out-of-pocket is even higher (depending on what actually "counts" toward the out-of-pocket maximum. This is a huge risk exposure for most families. Those with a family member who has a chronic illness, and who pay such a large out-of-pocket max every year, would likely be wiped out in short order.