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What to do when a health crisis pushes you over the limit

In an age when out-of-pocket costs for healthcare keep rising, you might take (small) comfort in the fact that insurers are required by the Affordable Care Act to provide a cap on how much a person is compelled to spend in a year. When the annual out-of-pocket maximum kicks in, insurance starts to pay 100 percent of covered charges and the consumer is spared further co-pays. What makes it complicated - and not all that reassuring - is that there are obscure rules about what counts toward the cap and what does not, and there are many different levels of caps depending on what type of plan you have. Most Americans have a hard enough time understanding the fine print of premiums and deductibles without worrying that they will be among the 1 percent or so who have a serious health event that pushes them up against the cap, says Karen Pollitz, senior policy fellow at the Kaiser Family Foundation. The most difficult part of the out-of-pocket max to understand is that the number applies only to in-network services. You could still owe your share for out-of-network services, which do not generally have a cap, said Pollitz. The law sets an overall maximum cap of $7,150 for an individual in 2017, and double that for a family. However, many employer health plans have much lower targets than that - 14 percent of Americans are in a health plan with an out-of-pocket max of less than $2,000, according to KFF. Getting a health wake-up call changed Jaime Chiang's whole approach to health insurance last year, after she was the victim of a crime and suffered multiple injuries. Chiang had been a healthy Silicon Valley branding executive, not paying much attention to the fine print of her health insurance plan, in November 2015.

"I liked to have a plan that allowed me to see the doctors I wanted. Numbers didn't interest me," says Chiang, now 39. When the first bill came, it was for $22,000 because the emergency room she was taken to was not in-network. While various insurance companies duked it out over who was responsible, Chiang still had to pay her share for the follow-up care she needed, which was extensive. Then she worried about what happened when she crossed into a new calendar year and hit a refreshed deductible and out-of-pocket maximum. "It was creating a secondary trauma dealing with all the bills," she said. Chiang ended up going to a medical billing advocate, Remedy (, and is just now getting clear answers.

Many Americans struggle with medical bills even before reaching the max. A 2016 study by Guardian Life Insurance found that 60 percent of Americans could not pay a $3,000 medical bill. Out-of-pocket costs overall are rising much more quickly than other healthcare costs, says Emily Adrion, a lecturer on global health policy at the University of Edinburgh, who authored a study on costs that was released in June. From 2009 to 2013, out-of-pocket spending had an annual growth rate of 6.5 percent, while overall health spending rose just 3 percent a year in the same time frame. "It's the back-end things you have to look at," says Adrion.

For consumers concerned about covering bills, there are supplemental insurance policies that some employers offer or can be purchased on the individual market. But KFF's Pollitz notes that consumers should be aware that these plans are not required by law to cover pre-existing conditions. "If you had cancer before, they won't sell it to you," she said. Consumers can also become more educated about what their policies cover and try to save accordingly. That's what Chiang is doing as she shops for a new health plan this year. No matter how much more informed she is, however, she still feels that the process is set up to exclude her from the information she needs. "I'm much more conscious now, but it's still a little bit of a gamble," Chiang said. "What do I think is going to happen, and how much money am I going to make and what do I need to feel safe? I'm aware, but I can't say I'm fully prepared."

Your money how to stop sneaky grey charges on credit card bills

(The writer is a Reuters contributor. The opinions expressed are his own.)By Chris TaylorNEW YORK Aug 24 Hey, remember that newsletter that let you sign up for a free trial?Didn't think so. How about that old domain name you registered, or your kid's gaming membership, or the magazine subscription that was initially offered as a freebie. Forgot about those too, didn't you?Rest assured those companies didn't forget. But they are probably counting on you to do so. That way they can keep charging your credit card, every year or every month, in perpetuity. And you may not even realize what is going on. There is even a name for all these sneaky little ongoing fees: 'Grey Charges'."Nine out of 10 people don't check their credit-card charges carefully," says Mick Weinstein, vice president of software company BillGuard. "And even if they do, it's too time-consuming to dispute those charges. So most people simply let them go."Such fees are not illegal, per se. But they are designed to keep you on the hook.

The result: 233 million grey charges a year, amounting to a whopping $14.3 billion dollars, according to a 2013 study by industry analysts Aite Group. That is an average charge of $61 per credit card bill. Just ask Holly Gordon. When the healthy-living consultant from Shawnee, Oklahoma downloaded software called 'You Need a Budget', she started discovering all sorts of little charges she had completely forgotten about."I was horrified at the number of surprise subscriptions we had," says the 47-year-old. To wit: Auto-paying for satellite radio since 2009, spending almost $200 annually, along with another $15 every month on various magazine subscriptions on Amazon's Kindle device."Those pesky one-time, quarterly and annual fees just kept popping up, sending my budget into panic mode," Gordon says. The most common grey charge, according to the Aite Group report: "Free-to-paid," where a free introductory period expires and a paid subscription kicks in. Those amount to more than 115 million transactions a year, at a cost of more than $6 billion.

There are plenty of other types of grey charges, too - many with frightening monikers. "Phantoms" are additional products or services tacked onto another transaction. "Zombies" are subscriptions or memberships that keep charging you, even after you have canceled them. REVIEW STATEMENTS Step one for consumers is to go over your credit-card statement with a fine-tooth comb every month, instead of just blindly paying up.

"Grey charges make it even more important to scrutinize your credit card bill and really look at every charge - especially if you are on auto pay," says Michael Schreiber, editor-in-chief and chief content officer of"Often people just scan and look for big charges that they don't remember making, or just the total amount due," Schreiber notes. "But those little charges can really add up."If you do discover a sketchy charge, take it up with the merchant or the credit-card issuer. Even if they don't give you credit for past charges, at least you can nix them going forward. Most of all, don't think of a grey charge as a minor issue that is not worth your time. After all, even a measly $5 a month turns out to be $60 a year, which turns out to be $300 over five years. With BillGuard's smartphone app, you can even let its staff dispute grey charges for you. Chicagoan Zach Moss, for instance, once purchased a one-day Boingo Internet pass - and then started to get dinged $9.99 every month. After a few smartphone taps, BillGuard challenged those charges, and Moss got refunded for three full months. Indeed, the payoff can be major. In part because Gordon started rooting out and killing all those grey charges - think of it like weeding a garden - she and her husband now expect to be out of consumer debt by the end of the year."It's so easy to put your money on auto-pilot and just zone out," Gordon says. "But it always comes back to bite you."

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