Since the Congressional Research Service reported that the Obama administration had missed as many as one- third of ACA’s legally required deadlines – and that report was circa November 2011 – the government has announced it won’t be able to verify individuals’ eligibility for ACA exchange subsidies until 2015 – relying on “the honor system” for a full year. Also delayed 12 months is the employer mandate requiring those with more than 50 employees to offer health care. And even while benefits administrators are still planning around that change, another yearlong delay has come to the fore: limits on out-of-pocket spending.
According to the law, starting in 2014, health plan participants will be spending no more than $6,350 in total out-of-pocket costs for individuals and $12,700 for family plans. That cap on out-of-pocket spending has been delayed until 2015, however, if an employer is using two separate vendors for its medical and pharmacy benefits. Sandy Ageloff, Southwest health & group benefits leader for Towers Watson, says the rule only applies “to nongrandfathered plans” and emphasizes that the delay only applies to those who split their services.
