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After that level, the law caps out-of-pocket payments to a maximum of $6,350 annually for an individual, or $12,700 for a family.

For La Voie, who makes less than 200 percent of the federal poverty level, the law caps out-of-pocket costs at $2,250 for individuals.

Proposed and final rules issued this spring surprised many by failing to bar large employers from offering insurance policies that could exclude benefits such as hospitalization. Offering bare-bones policies may result in some fines, but that expense could be less than the cost of offering traditional medical coverage. For large employers, "the feds imposed no minimum standard on how skimpy that coverage can be other than to say, in essence, it's got to be more robust than a dental plan or a vision plan," said Ed Fensholt, a senior vice president at insurance broker Lockton Companies. "We had customers looking at offering some relatively inexpensive and skimpy plan designs to satisfy the individual mandate at modest cost.”

The bare-bones plans cannot be offered to small businesses with fewer than 50 workers, or to individuals buying coverage through new online marketplaces that open for enrollment Oct. 1. But benefit experts expect some larger firms that buy outside the marketplaces or that self-insure to consider them. 

Skimpy insurance under the Affordable Care Act won’t be quite the same as it is now. Under the new rules, capping the dollar value of annual benefits isn't allowed, but excluding entire categories from coverage - such as hospital stays - is permitted, say benefit consultants. That's another way of keeping costs down.

Medicare patients, however, are at a disadvantage because there is no cap for out-of-pocket expenses. They "are paying copayments or coinsurance forever," Dr. Newcomer explained.

"What we are already seeing is that patients who are on Medicare are coming to hospital settings; they are not being treated at their doctor's office or their infusion center because the doctors can't afford to do it," said Dr. Swain. The doctors would actually lose money on this, so the patients are coming to a higher-priced facility — a hospital — to get their infusion, she explained. "I think it is really going to have an effect, not on the patients but on the economy in general," she added.

The decline in Medicaid budgets has added challenges to medication access for recipients of this program.