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Covered California Q&A

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.


Out of Pocket Caps Delayed?

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Question: Say it isn’t so! Can you please clarify on this delay? I heard something on Anthem’s webinar yesterday that it only affects those using separate service providers? Needing better clarification. Please advise.

Answer: OK, it may not be so. What we’re talking about here is the individual annual out-of-pocket limit (OOP) set by the ACA at $6,400 per year including prescription medication. The feds waffled on this, setting an additional OOP limit of $6400 on prescription drugs, for a total annual OOP limit $12,800 for 2014. But hold the presses, California may again outdo the feds. If Senate Bill 639 by Sen. Ed Hernandez is passed by the Legislature this year and signed by the governor, it will make the total OOP $6400 after all. It may not even matter, as Covered California has already set the OOP at $6,400 as originally intended by the ACA. They are checking now to see if they would have to follow the Feds.

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