6,350 Reasons Obamacare's Maximum Out-Of-Pocket Limit Is Defective

November 05, 2013

Before we go any further, no this isn't a list of 6,350 complaints about the new Affordable Care Act compliant health insurance plans. It is however the sum of one major reason these new plans took a step in the wrong direction.

That number, 6,350, is the dollar limit the ACA put on all health insurance policy's maximum out-of-pocket for a single person. It's $12,700 for a family (two or more people).


If you're unfamiliar, the maximum out-of-pocket is the total amount of money you would have to pay for covered, in-network medical treatment during the calendar year.

That's $350 higher than the highest Health Savings Account deductible available prior to "Health Care Reform."

The worst part about all this? It shows up on almost every plan.

The Breakdown

Medical Mutual is offering seven "Obamacare" health insurance plans, four have MOOP of $6,350 and only one under $5,000.

Here's a more detailed look at their MOOP broken up by medal tier:

2 Gold Plans

  • 1 - $5,000
  • 1 - $2,000

1 Silver Plan

  • 1 - $6,350

3 Bronze Plans

  • 2 - $6,350
  • 1 - $6,000

1 Catastrophic

  • 1 - $6,350

Reminder: These numbers are doubled for families.

Anthem Blue Cross Blue Shield has 14 total plans available inside Ohio's Health Insurance Marketplace. 7 of them, all bronze level plans, have a maximum out-of-pocket of $6,350.
and one with a $6,000 MOOP.

Only three of their 14 plans have MOOP's below $5,000.

2 Gold Plans

  • 2 - $5,000

5 Silver Plans

  • 1 - $6,000
  • 1 - $5,500
  • 1 - $4,500
  • 1 - $4,000
  • 1 - $3,750

7 Bronze Plans

  • 7 - $6,350

What's Your Point?

Compared to today, I pulled up 185 different plan options, every plan I would have recommended or sold you (there's about 10-20 per company) has a MOOP of $4,000 or $5,000.

That's 30 or 40 different health insurance options with MOOP's under $5,000 dollars compared to four today.

Of course, there were plans that had $10,000, $15,000 or even $25,000 deductibles and MOOP's. Just because they were offered doesn't mean you had to buy them.

It's kind of a like the old, if a tree falls in the forest thing... If a health insurance policy is offered, but no one buys it, does it really exist?

I guess my point is, those crazy deductible plans weren't doing any harm to your health insurance, as long as you didn't buy them, by just "being there."

Now, if you chose to handle your health insurance on your own, it's very likely/possible you ended up with one of those plans if you only looked at the "window benefits" and didn't take the time to drill down to the most important numbers.

Why's This Happening?

No one will ever confuse me with a mathematician, but the combination of that MOOP limit, new mandatory benefits, no more exclusions for pre-existing conditions and the 3 to 1 limit on age rating put some pretty tight handcuffs on the insurance companies to crunch numbers and create plans that you would want to buy and more importantly be able to afford.

That's the best the two "pre Obamacare" leaders could do.

What Now?

You are more than likely going to find yourself buying one of these "new" policies sooner rather then later.

The entire point of this MOOP break down is to make you aware of this regression of sorts and to start viewing this historic law as a work in progress instead of a done deal.

The best thing "Obamacare" did for this country was prove that change could happen inside the health insurance industry. We have a long way to go before we get everything right. If that's ever going to happen, you are going to need to be aware of these imperfection and demand change that produces better results.

The Bottom Line

If you need more than 6,350 reasons, I mean dollars, to prove that a majority of your health insurance options have become less attractive next year, I can't help you.

Adding an extra $1,350 - $2,350 dollars to most health insurance policy's bottom line is a little disappointing in my opinion. In addition to increasing your total monthly cost (unsubsidized).

The two most important things I've always said to look at (MOOP and Monthly Price) when buying health insurance just got more expensive for you.

Hopefully I will be able to provide you with a few answers next week in my "best of" Ohio Health Insurance Marketplace edition.

You Tell Me?

I just have one question today. You know where I stand, but is the increased max out-of-pocket a concern for you?