[
Under the Patient Protection and Affordable Care Act, members should not be
charged any cost-sharing (i.e., copayments, coinsurance, and deductibles) once
their annual limit for essential health benefits has been met. Therefore, to
avoid dissolution of capitation payments, Independence regularly assesses and
adjusts capitation rates for participating primary care physicians. Typically,
these adjustments are made to compensate for an increase in HMO members who
have reached their total out-of-pocket maximum for cost-sharing; however,
adjustments can also be made when there is higher membership in our High
Deductible Health Plans.
]