12 Jul Don’t Miss these Changes to the 2017 Health Insurance Marketplaces!
In March 2016, the U.S. Department of Health and Human Services released new rules for the health insurance marketplaces. These marketplaces are available to people who want to purchase their own health insurance in any of the 38 states that use the online federal marketplace (www.HealthCare.gov) or to any of the 13 states and District of Columbia that host their own health insurance marketplaces.
In a recent article published by Kaiser Health News, they provide a summary of three specific changes that may affect consumers using the 2017 federal marketplace (www.HealthCare.gov):
- Increased consumer access to information about the size of an insurers’ network of doctors and hospital.
New rules require insurers to give consumers 30-days’ notice if a provider is being removed from the health insurance plan’s network. Insurers must also provide continued coverage for up to 90 days for patients in active treatments (e.g., chemotherapy, or for women in later stages of pregnancy) – unless the provider is being dropped for cause.
- Increased warning for “surprise” medical bills from out-of-network providers.
A patient’s ancillary care, such as radiology or anesthesiology, will count towards an insurance plan’s annual out-of-pocket maximum, if the insurer does not notify the patient (within 48 hours) that they may receive care and bills from out-of-network providers.
- More standardized out-of-pocket costs for consumers.
This new rule was designed to make comparison shopping between plan choices easier for consumers. Federal regulators have created six standard plans that they are asking insurance companies to voluntarily offer in 2017. These plans include specific costs for copayments, prescription drugs, primary care, mental health, and substance abuse treatments. This standardized plan design has been implemented in several states, including California, Oregon, and DC; and allows consumers to plan for possible expenses. But these plans have been opposed by insurance companies. Because of this opposition, consumers will likely see both standardized plans and the current varied policies available in the marketplaces. In addition to these plans, HHS has decided that the maximum amount that consumers can be charged for annual out-of-pocket costs is $7,150 for an individual and $14,300 for family coverage.