When the open-enrollment period begins Nov. 1, people who search for coverage via HealthCare.gov will see a new option standardized “Simple Choice” plans. Many Blues plans contacted by The AIS Report say they’re not offering such plans on the public exchanges. Moreover, in comments to CMS, Blues plan operator Anthem, Inc., the Blue Cross and Blue Shield Association and the trade group America’s Health Insurance Plans voiced their opposition to such plans.
Standardized plans will have uniform deductibles, out-of-pocket limits and copayments. Premiums, however, will vary. The plans will be displayed “prominently” on the website, according to CMS, and consumers will be able to choose to see only these types of plans, if they want to quickly compare them. CMS proposed the idea last November to make it easier for consumers to comparison shop. In a final rule released Feb. 29, the agency said carriers can continue to offer non-standardized plans.
In an Oct. 6 letter to HHS Sec. Sylvia Burwell, Anthem said standardized plans “stifle innovation” and are potentially misleading for consumers. The Blues plan operator explained that to the consumer, such plans appear equivalent, but could have substantial differences in formulary drug coverage and network access. Anthem suggested that HHS abandon the concept of a national system of standardized plan options for the 2018 plan year and beyond.
For the 2018 plan year, CMS proposed expanding the standardized plan framework. In an Oct. 6 letter to CMS, AHIP said such changes shouldn’t be made until consumers have an opportunity to assess the consumer experience of shopping for standardized and non-standardized plans.
A year ago, AHIP warned that making standardized plans available for the 2017 plan year would “increase the complexity of the decision-making process…by adding one more factor to consider.”
Standardized Plans in New York
In 2017, BlueCross BlueShield of Western New York, a unit of HealthNow New York, Inc., is introducing a bronze-tier standard plan that is eligible to be paired with a health savings account. The HSA can help members manage their higher deductible, explains spokesperson Kyle Rogers.
In New York, health insurers are required to offer at least one standard plan on each of the four actuarial metal tiers.
“The benefits and cost-sharing of these plans are largely the same between us and our competitors, though we have the ability to price based on the estimated utilization and costs in the markets we serve,” he says. Additionally, BlueCross BlueShield of Western New York is offering the Essential Plan, a lower-cost option for eligible individuals who do not qualify for Medicare, Medicaid, or Child Health Plus. The Essential Plan offers the same benefits as other plans, but features no deductible and premiums as low as $0 per month.
The Blues plan’s non-standardized plans include two tiered-benefit products, which feature lower premiums while giving members the option to manage their share of costs for health care services depending on where they elect to access care. Both plans feature a defined set of hospitals and specialists at the lowest cost-share.
Few Blues Offer Standardized Plans
Paula Sunshine, senior vice president and chief marketing officer at Philadelphia-based Independence Blue Cross, says based on the plan designs, the company determined Simple Choice plans would be the most expensive options on the silver tier in its market.
“It has been our experience that consumers in our market are price sensitive; therefore we decided against adding these options for next year. However, we will review them again for 2018,” she tells The AIS Report. For the 2017 plan year, Independence Blue Cross is the only insurer in the region that will sell coverage via the exchange, offering 12 plans through HealthCare.gov and 13 directly to consumers.
Horizon Blue Cross Blue Shield of New Jersey spokesperson Thomas Vincz says such plans need to meet certain state requirements, and the standardized plans proposed for HealthCare.gov don’t meet those requirements.
Cambia Health Solutions, which operates Regence Blues plans in Idaho, Oregon, Utah and Washington state, will not offer any standardized plans. Likewise, Arkansas Blue Cross Blue Shield and Pennsylvania-based Capital BlueCross decided against offering the plans.
Some SBEs Offer Standard Plans
Some SBEs, such as Covered California, already require standardized plans, and consumer groups have urged CMS to follow suit in the hopes that doing so would make comparison-shopping simpler.
Covered California has had a standard benefit design since the exchange opened its doors in 2013, something the exchange’s executive director, Peter Lee, has advocated. From the outset, consumers are able to easily compare plans because all the plans have the same standard benefit design, says Covered California spokesperson Roy Kennedy.
Washington, D.C.’s exchange began offering standard plans last year, and about 37% of customers enrolled. The plans have a special designation online and the word “standard” in their name.
Date: November 06, 2016