Modified Cost-Sharing Limits for 2014


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Last week it was announced that there would be a delay with respect to the new cost-sharing limitation for participants of employer-sponsored health plans under the Affordable Care Act (“ACA”).  The intent of this new cost-sharing limitation is to limit out-of-pocket annual costs for participants of employer-sponsored health plans to $6,350 for an individual and $12,700 for a family, beginning in 2014.  However, due to difficulties in the implementation process, the cost-sharing limitation, as provided under the ACA, has been delayed until 2015.

Accordingly, employer-sponsored health care plans will now be subject to a modified version of the cost-sharing limitation in 2014.  Under this modified cost-sharing limitation, the out-of-pocket annual cost limitations ($6,350 for an individual and $12,700 for a family) shall apply only to major medical coverage.  There will be no out-of-pocket cost limitation for other coverage (for example, prescription drugs), unless otherwise provided under the terms of employer-sponsored health plan.

 

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