QUESTION

I thought there was a cap on out-of-pocket costs but my prescription drug benefit requires me to pay co-pays even after I’ve met the out-of-pocket limit for other medical benefits. Is that allowed?

Post enrollment issues | Employer-Sponsored Coverage
ANSWER

Your employer plans can have a separate limit for your prescription drug coverage, but the total of all out-of-pocket caps combined cannot be more than $8,700 for an individual or $17,400 for a family in 2022. (86 FR 24140, 24235, May 5, 2021).

Individuals with no coverage
Individuals with coverage
Coverage for small employers
Post enrollment issues