Under the Affordable Care Act, carriers are allowed to amend their plan designs each year under an inflation factor to keep their “exposure” constant,which means that the exposure for the patient will increase to also keep his exposure constant. For 2020, the out-of-pocket maximum allowed is $8,150 for individual coverage and $16,300 for family coverage.
When CMS announced these new limits, they also said that starting in 2020 plans are permitted, but not required, to exclude drug manufacturer coupons from counting toward a covered person’s annual out of pocket maximum IF a medically-appropriate generic drug is available.
