2022 A.C.A. Cost Sharing and Out of Pocket Maximums

Under the Affordable Care Act, the U.S. Department of Health and Human Services (H.H.S.) releasing rules on small group and individual health insurance plans and large group health plans. These notices typically impact the out-of-pocket max on a health insurance plan, employer shared contribution limits, and the enforcement of existing rules.

2022 Out of Pocket Maximums

  • On Individual coverage- the self-only out-of-pocket maximum cannot exceed $8,700.
  • Family coverage- The out-of-pocket maximum cannot exceed $17,400.This is a 1.8% increase from the 2021 limits.

Health Saving Accounts (H.S.A.)

Health Saving Accounts or High Deductible health plans have different limits than the “traditional” co-pay plans. 2022 the individual out of pocket for an H.S.A. plan is $7,050, and the family is $14,100.
Prior year H.S.A. was $7,000 individual and 14,000 families.

H.H.S. is trying to control the out-of-pocket maximums; in 2021, we saw an almost 5% increase compared to 1.9% for 2022. The reality is most Americans can’t afford the current out-of-pocket maximums, so any increase is too much. The out-of-pocket increase is not reducing the premiums in Indiana. Most people can only afford individual health premiums by receiving premium assistance through the marketplace. 2021 & 2022, the Gov. has lifted the salary limits to qualify for premium assistance. The premium assistance provides that one pays less than 10% of their household income in health insurance premiums. This is going to be a key component to the affordability of the individual health insurance market. Right now, there is no incentive for carriers to reduce their premiums.

The small group A.C.A. market has genuinely become unaffordable for most small businesses. This has become a high-risk pool market in Indiana and most of the country. High Risk means you are unable to purchase a group underwritten plan because of ongoing health conditions. Some of the increased risk is being generated from biologics drugs which are highly effective but very expensive. Eventually, this market will have to be subsidized by the government, or it will collapse.
H.H.S. is going to enforce transparency rules for both medical and pharmacy providers. Both industries have had little to no transparency when it comes to cost. Hopefully, these new rules will help to reduce health care costs that continue to skyrocket.

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