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Out of Pocket Limits

Questions answered

The Affordable Care Act requires QHPs (Qualified Health Plans) to provide certain recommended preventive health services without cost sharing or deductible requirements.

All QHPs must limit cost sharing for enrolled individuals in the following ways:

  • Deductibles and copays cannot be applied to preventive services.
  • Deductibles for small group plans cannot exceed $2,000 for self-only coverage or $4,000 for any other coverage (adjusted annually), except to the extent that a higher deductible is necessary to create a reasonable bronze or silver plan.
  • Annual cost-sharing limits cannot exceed the limits for certain high deductible health plans including catastrophic plans. (For 2014 the limits are $6,350 for an individual and $12,700 for families.)

No annual or lifetime dollar limits are allowed on EHB beginning January 1, 2014. 

Next Topic: Other Plan Types



Agents and Brokers are required to be trained to assist consumers with the application and decision making process. Using an Agent to enroll in a ObamaCare Health Plan will be the primary choice of many americans. After all agents have the inside track on companies and their promptness to handle claims and pay benefits in atimely fashion.

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*ExploreObamacare.com is not affiliated with any government agency. All information provided is for informational purposes only and no guarantee of the accuracy is hereby implied. The information was the product of researching the Affordable Care Act Bill and is subject to change.
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