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.