How Much Will People Pay Out-of-Pocket?
| State/Plan |
Maximum Out-of-Pocket Chargesª
(deductibles and cost-sharing) |
California
AB8 |
Individual |
TBD |
| |
Family |
TBD |
| Governor's Proposal |
Individual (under individual mandate) |
$7,500 (deductibles capped at $5,000) |
| |
Family |
$10,000 |
Illinois
Illinois Covered* |
Individual |
TBD |
| |
Family |
TBD |
Maine
Dirigo Health |
Individual (below 300% FPL) |
$700-$3,200 |
| |
Individual (above 300% FPL) |
$3,500-$5,600 |
| |
Family (below 300% FPL) |
$1,400-$9,200 |
| |
Family (above 300% FPL) |
$7,000-$11,200 |
Massachusetts
(Health Reform 2006)
Commonwealth Care |
Individual (below 300% FPL) |
No deductible, nominal cost-sharing |
| |
Individual (above 300% FPL) |
$5,000 |
| |
Family (below 300% FPL) |
No deductible, nominal cost-sharing |
| |
Family (above 300% FPL) |
$7,500 |
| Individual Mandate |
Individual (below 300% FPL) |
N/A |
| |
Individual (above 300% FPL) |
$5,000 (deductible capped at $2,000) |
| |
Family (below 300% FPL) |
N/A |
| |
Family (above 300% FPL) |
$10,000 (deductible capped at $4,000) |
New Jersey
Sen. Vitale's Proposal |
Individual |
TBD |
| |
Family |
TBD |
Pennsylvania
Prescription for Pennsylvania |
Individual |
TBD |
| |
Family |
TBD |
Vermont
Catamount Health |
Individual |
$800 (deductible capped at $250) |
| |
Family |
$1,600 (deductible capped at $500) |
Washington
Health Reform Enacted in 2007 |
Individual |
TBD |
| |
Family |
TBD |
Wisconsin
BadgerCare Plus |
Individual (below 200% FPL) |
5% Income (including premiums) |
| |
Individual (above 200% FPL) |
TBD |
| |
Family (below 200% FPL) |
5% Income (including premiums) |
| |
Family (above 200% FPL) |
TBD |
*This reflects proposals contained in Senate Bill 5 as of May 2007. Subsequent amendments are changing some of the bill's provisions.
ª Specific maximums have been determined by law except in Maine, where current out-of-pocket maximums are set by agency.
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