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Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

Deductibles included in Out-of-Pocket Limit?

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Question: For Covered CA plans, are deductibles included in the out-of-pocket limit. When I was shopping for individual plans earlier this year for 2013, I believe Kaiser included the deductible in the OOP limit so the max of my cost-sharing is the OOP limit, but for Anthem deductibles weren’t part of the OOP limit so the max of my cost sharing is the deductible plus the OOP limit. Will it continue to differ by company in the 2014 Covered CA plans or is this standardized?

Answer: Yes. Deductibles are included in the out-of-pocket maximum for all plans both in Covered California and off-exchange. Standard plans is one of the primary consumer benefits afforded by the ACA. The current situation you described above made it impossible to compare plans across all carriers on an apples-to-apples basis.

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