Healthcare Series

Healthcare law changes limits and maximums

CREATED Dec. 12, 2013

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MILWAUKEE - Before the Affordable Care Act, caps on the amount an insurance company would pay to you were common.

"It was pretty common for an insurance policy to have a lifetime limit of a million dollars.  So once they paid a million dollars toward your medical care over the course of your lifetime, they wouldn't be required to pay anything else out," said Jennifer Johs-Artisensi, an associate professor of healthcare management at UW Eau Claire.  
The maximum pay out limit is already gone.  That went away as soon as the President signed the bill into law several years ago.  Beginning next year, there will also be a limit on how much you will have to pay for your care.
For individuals, you wouldn't have to pay more than $6,350 dollars on top of your premium cost.  For families, the number is $12,700.
The idea is to keep the cost of healthcare from ruining your finances.  "It would prevent you from having to file bankruptcy or maybe losing your house, there would be a limit on how much you'd be required to pay," Johs-Artisensi said.
That sounds good, but someone has to pay for that.
The thinking is that the way the law is set up will lead to offsetting savings elsewhere.
The belief is that you'll actually save money by offering coverage to people who don't have it now.  Right now, many people without insurance go to an emergency room when they need care.  By law, emergency rooms have to treat people, even if they can't pay.
If you get those uncovered people covered, "They'll use healthcare services more appropriately and we won't have these high, expensive emergency room costs," Johs-Artisensi said.