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There is no simple solution to the hospice payment cap issue.
To reach his success payment cap of $33 million, Adelphia's exit value would have to grow to just $13.9 billion, or $2,400 a subscriber.
But the consultation says: "The government's strong expectation is that, consistent with the approach taken to exit payment recovery, bodies that are proposed to be outside the scope of the cap on exit payments will set out a commensurate cap on exit payments, at least equivalent to the arrangements proposed, and introduce this no later than the exit payment cap".
"When looking at ARMs, the consumer needs to be aware of the payment cap in addition to the rate cap," says Edward Powell Edward Powell, chief consumer officer at Lending Tree in Charlotte, N.C.
And though prospects for health care reform remain contentious, a genuinely bipartisan consensus has emerged that no insurance company should be permitted to deny coverage to someone because of their pre-existing medical condition or cut off benefits because a claimant has exceeded his or her lifetime payment cap.
Moreover, there are many restrictions in terms of benefit packages, payment cap, and co-payments.
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Professor Giannelli says some state payment caps are low, "in the hundreds of dollars".
He said the government had moved "from a system of direct payments to farmers where there are income restrictions and payment caps to a world without any restrictions on how much you can get in these insurance subsidies".
Co-pays, deductibles, out-of-network providers and lifetime payment caps all become part of Shep's vernacular, first as he navigates his wife's illness and treatment, then as his octogenarian father breaks his leg and must be moved, at Shep's expense, into a nursing home.
In Hoboken, a developer of 76 one- and two-bedroom condominiums on Adams Street is seeking to snare buyers with a fat package of incentives, including a chance to win a paid two-year lease on a BMW, a down payment capped at $2,500, fully paid closing costs and no common charges for a year.
Some programs impose per-episode out-of-pocket payments caps, promising to cover any costs in excess of that cap, while others impose insurer payment caps, requiring participants to cover any cost over the cap.
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Justyna Jupowicz-Kozak
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