Question: I have heard of the limit to tier 4 drugs. Can you elaborate on this as well any other changes like deductibles, co pays, coverage e passion etc?
Answer: In 2016, all metal-tier plans will now have a maximum monthly out-of-pocket cost on specialty drugs (once the pharmacy deductible is met). For the Bronze Plans there is a $500 monthly maximum and for Silver, Gold, and Platinum the monthly out-of-pocket maximum is $250 after the pharmacy deductible is met. The other significant change in benefits for 2016 affects the Bronze Plan. The first cumulative three visits will not be subject to a deductible and can include a specialist visit in addition to primary care, mental health and urgent care visits. In addition, laboratory work is not subject to the deductible.