National Health Council Statement on CMS Out-of-Pocket Cap for Family Plans

Washington, DC (September 17, 2015) -- The National Health Council (NHC) commended the Centers for Medicare and Medicaid Service (CMS) for its decision to proceed with a proposal to apply individual out-of-pocket cost limits to people who purchase family coverage health insurance plans.

CMS’ decision was unveiled in a letter sent to employers and reported in the media. The NHC views this decision as greatly benefiting people with chronic diseases and disabilities by helping them afford their medical services and medications.  

As NHC Chief Executive Officer Marc Boutin pointed out in his August 3 letter to the administration, for people with substantial health needs, out-of-pocket costs such as copays and coinsurance make up the bulk of their health spending. The maximum out-of-pocket limit is one of the greatest provisions of the Affordable Care Act that protects people with chronic conditions from discrimination, and the NHC fully supports any attempts to strengthen this protection. The policy to apply individual out-of-pocket cost limits to people with family coverage may prevent people from paying up to twice as much in out-of-pocket spending.

To read the full text of the NHC’s August 3 letter and past comments on the importance of setting an out-of-pocket limit for patients, visit

About the National Health Council –

Founded in 1920, the National Health Council (NHC) is the only organization that brings together all segments of the health community to provide a united and effective voice for the more than 133 million people living with chronic diseases and disabilities and their family caregivers. Made up of more than 100 national health-related organizations and businesses, its core membership includes the nation’s leading patient advocacy organizations, which control its governance.


Nancy Hughes,, 202-973-0550