2015 Cost-Sharing Limits for ACA Compliant Plans

Below is from BCBS of Illinois. Note the link to the final rule. Also note that if the health insurance provider cannot meet the Medal requirements (for Bronze, Silver, Gold) with such a low deductible, then they are allowed to make it higher than the limit. This is what we are seeing in the market today.

From BCBS of Illinois

Legislative Update 
2015 Cost-Sharing Limits

The U.S. Department of Health and Human Services’ Notice of Benefit and Payment Parameters for 2015 final rule set the following cost-sharing parameters for 2015.

• Out-of-pocket Maximum: The maximum annual limit on cost sharing will be $6,600 for self-only coverage and$13,200 for family coverage. As a reminder, if a plan is non-grandfathered, out-of-pocket member expenses for in-network essential health benefits (EHBs) cannot exceed these out-of-pocket limits.

• Deductible Limit for Small Groups (1-50): The maximum annual limit on small group deductibles will be$2,050 for self-only coverage and $4,100 for family coverage. As a reminder, non-grandfathered small group plans must cap deductibles for in-network EHBs at these amounts.

• Pediatric Dental Coverage: Stand-alone pediatric dental plans covering pediatric dental EHBs will have cost-sharing limits of $350 for coverage of one child and $700 for coverage of two or more children.

This communication is intended for informational purposes only. It is not intended to provide, does not constitute, and cannot be relied upon as legal, tax or compliance advice. The information contained in this communication is subject to change based on future regulation and guidance.

New World, New Rates for Obamacare (Affordable Care Act). How it impacts Me.

The first thing I did this morning when I got to the office was to try to get into healthcare.gov. When that didn't work, I knew I could still get rates via each individual carrier. So I worked and got the three closest plans to what I have now to compare current plans and rates to plans and rates 1/1/2014. Here is what I found.

My current plan is a $5200 family deductible HSA plan via Blue Cross Blue Shield of Illinois. It pays 100% after I meet the deductible. My current premium is about $600/month for a family of 4.

Below is a snapshot of the three closest plans I could find. (Land of Lincoln, BCBS of IL, and Aetna respectively).

The first thing I noticed was that I COULD NOT find a plan similar to what I have now. Furthermore, the smallest out of pocket maximum for a family was OVER $12,000 for an HSA compatible plan.

You may say that $758.97/month is reasonable, but please remember that I was paying less than $600/month for better coverage ($5200 maximum out of pocket for everything instead of $12,700 maximum out of pocket).

I tried quoting Coventry, but their website said there were no plans available and Health Alliance's rates were high and not as graphic as above because they just have rate sheets. Of course those two carriers are not available in DuPage County, so that is another reason I didn't list them here. DuPage County only has BCBS of Illinois, Aetna, and Land of Lincoln.

Now you may be saying that these are unsubsidized rates and you'd be correct. We need to keep in mind that SOMEBODY is paying for the plan, even if your share is at 50%. Note also that two out of 3 plans are Bronze level plans meaning that the costs are less than a Silver plan. Unfortunately, there were no Silver plans that were similar to what I have now. They just weren't offered. 

I'll be curious to see the comparison once the government website is up and running. More posts as the time goes on.

New HSA Guidelines for 2013

Here are some highlights for 2013.

Annual:	2013	2012
Minimum Individual Deductible	$1,250	$1,200
Minimum Family Deductible	$2,500	$2,400
Maximum Individual Out-of-Pocket (in network)	$6,250	$6,050
Maximum Family Out-of-Pocket (in network)	$12,500	$12,100
Maximum HSA Individual Contribution	$3,250	$3,100
Maximum HSA Family Contribution	$6,450	$6,250

1. Maximum contributions are $3250 for an individual (up $150) and $6450 for a family (up $200). Person’s aged 55 years old and older can add an additional $1000/year as a catch up contribution (no change).
   
   
2. Minimum Deductibles are the same. The minimum deductible for an individual plan is $1,250 and for a family it is $2,500.
   
   
3. Catch up contributions for those 55 years old and older is still $1,000/year.
   
   
4. Maximum out of pocket has changed. The maximum out of pocket (including deductible) on an individual plan is now $6250 (up $200) and for a family it is $12,500 (up $400).

Items that haven’t changed, but are beneficial to know.

• You can put the full amount in immediately without waiting (This even applies to new hires or a person starting an HSA qualified health plan in the middle of a calendar year).
  
  
• You can put the maximum contribution into your HSA account, regardless of your deductible.

• A person can choose to accumulate HSA qualified expenses over the course of years (instead of taking the expenses out of the HSA account at the time of service). Every year they need to fill out a Form 8889 and carry the balances forward. At 65 years old, they can then take a distribution equal to the total amount of expenses incurred tax free.

• An individual can take a one-time distribution from their IRA to fund their HSA account.

• As always, you have until April 15^th (or when you file your taxes) to contribute to your HSA savings account for last year.

Check with your accountant for more information on how this would specifically apply to you.

Here is a link to the original IRS announcement: http://www.irs.gov/pub/irs-drop/rp-12-26.pdf.

Copyright 2012 Robert C Slayton