Employer Plans Beware: Alternative Funding Programs May Be Riskier Than They Appear

Health Affairs November 14, 2024
Ashira Vantrees

Two key pillars of the Affordable Care Act (ACA) are its creation of essential health benefits (EHBs) and its imposition of annual limits on cost sharing. The ACA’s annual limits on cost sharing were designed to reduce health-related debt by establishing the maximum amount of out-of-pocket expenses individuals would be required to pay during a plan year. Meanwhile, the 10 categories of EHBs are items or services that all ACA-regulated plans must cover. Prescription drugs are one of the 10 EHBs. A designation as an EHB is important because all cost-sharing payments for an EHB must count toward a consumer’s annual limits on cost sharing. This requirement applies to all non-grandfathered health plans, including Employee Retirement Income Security Act of...

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