New Bill Helps Californians Track Out-of-Pocket Health Care Spending

For Immediate Release: Wednesday, March 17, 2021

Rachel Linn Gish, Director of Communications, Health Access California,, 916-532-2128 (cell)


SB 368 (Limón), which is being heard in Senate Health Committee today, provides health consumers with the knowledge of how close they are to meeting their deductible and other spending limits, helping them better plan for their health care and other financial needs

SACRAMENTO, CA – Today, the Senate Health Committee will hear a key patient protection bill, Senate Bill 368 (Limón), that would require consumers to receive timely and accurate information about their progress over the course of a year in meeting their deductible, out-of-pocket maximum, and other spending limits.

Our health care system requires many consumers to pay for a share of their health care through deductibles and other out-of-pocket spending. Thankfully, the Affordable Care Act capped the lifetime amounts that a person must be forced to spend on care throughout their lives. This was a huge relief for many Californians who face high-cost medical needs and were often forced into bankruptcy to cover medical bills. But these same Californians must still meet deductibles and other spending limits before financial help kicks in. For these individuals, it’s vital to track these accruals so they can make financial planning decisions for themselves and their family, and better manage their health conditions. Currently health plans already track this information for their records, but it is not shared with consumers unless explicitly requested. SB 368 by Senator Limón requires health plan regulated by the Department of Managed Health Care to track and communicate accruals to enrollees.

“People already experiencing significant health needs should have access to the same up-to-date deductible information health plans have available,” said Senator Limón, author of SB 368. “SB 368 provides consumers accurate and timely information on the cost of care they need, and can better budget their health and financial needs.”

Health care spending for some can be significant. Many deductibles are over $1,000 and Covered California silver-level plans have deductibles of $4,000 for hospital stays. Consumers in the individual market may have deductibles as high as $7,000 or even $8,000. On top of this, every Californian with private coverage has a maximum out-of-pocket limit for covered essential health benefits. Though only a small percentage of people incur costs that put them close to their out-of-pocket limit, those that do meet this limit are the ones with the most burdensome and expensive-to-treat conditions. Major health care needs that add up quickly could include those relying on MS drugs, those with HIV/AIDS and someone undergoing cancer treatment.

Despite the significant financial impact of deductibles and maximum out-of-pocket limits, consumers are often left with little help from insurance plans in tracking their accrual towards these amounts — even while their health plans have ready access to this information. Underserved communities may particularly suffer from this lack of transparency and face additional challenges, such as language barriers and health and financial literacy, that make keeping track of their payments even more difficult.

“SB 368 shifts the burden for tracking these accruals from people to the health plans,” said Diana Douglas, policy advocate for Health Access California, sponsor of SB 368. “With regular communication on spending towards these limits, Californians can better stay on top of their health and financial well-being.”

SB 368 will be heard today in Senate Health Committee which begins at 1:00pm.


FACT SHEET: SB 368 (Limón): Helping Consumers Keep Track of Their Deductibles and Maximum Out-of-Pocket Expenses