Health insurers warned that giving states the ability to define their own essential health benefits will confuse consumers and undermine the insurance markets.
Health insurers warned that giving states the ability to define their own essential health benefits will confuse consumers and undermine the insurance markets. In comments to CMS published Monday, insurers that sell plans on the individual and small group markets said they are afraid they will bear the burden for greater healthcare costs if CMS follows through with plans to allow states to define their own benefits annually starting in 2019.
Anthem, which has drastically scaled back its 2018 participation in the Affordable Care Act (ACA) exchanges, said the proposal “may lead states to expand benefits under their benchmark plans without defraying the costs of such benefits, increasing the cost of coverage.”
Centene Corp, the dominant exchange insurer with more than a million individual marketplace members, said the CMS plan would be “more of a burden than a benefit to the market.” Molina, Kaiser Permanente, and the Blue Cross and Blue Shield Association echoed Anthem and Centene's concerns.
The news was reported in Modern Healthcare Monday.
The proposal would allow states to define the essential health benefits that health insurers in the state must offer, rather than having the federal government define those 10 benefits. States could:
The agency said states could make changes to the benefits each year. CMS aims to give states more flexibility that could potentially lead to more affordable health plan options in 2019. However, health reform experts worry that that the changes will lead to a rise of less costly yet less robust plans on the market.
Currently, all individual and small group health plans provide coverage for 10 benefits defined under the ACA, including emergency services, hospitalization, prescription drug coverage, maternity care, and care for mental health and substance abuse disorders, among others.
Kaiser Permanente, which owns Kaiser Foundation Health Plan, said in a comment that it opposes using “a typical employer plan” as defined by CMS as a guide for the essential health benefits.
In its proposed rule, CMS said the package of essential benefits must be in line with a “typical employer plan” in the large or small group market with more than 5000 enrollees. However, self-funded employer plans are often customized to fit a specific population, Kaiser Permanente said.
Aetna said that while the company generally supports CMS’ proposal, changing the benchmark plan every year would cause too much unpredictability and lead to market instability.
Standard Criteria for Loss of Ambulation Needed in DMD
April 19th 2024A recent study suggests the differences between ambulation definitions for patients with Duchenne muscular dystrophy (DMD) can impact the identification of ambulant vs nonambulant individuals, and standard criteria across settings are needed.
Read More
Navigating Health Literacy, Social Determinants, and Discrimination in National Health Plans
February 13th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the February 2024 issue of The American Journal of Managed Care® about their findings on how health plans can screen for health literacy, social determinants of health, and perceived health care discrimination.
Listen
An Overview of Health Care and Pharmaceutical Trends, 2023-2024
April 19th 2024Douglas M. Long, BA, MBA, was featured as the keynote speaker on the closing day of The Academy of Managed Care Pharmacy 2024 annual meeting, with a session dedicated to surveying the health care and pharmaceutical trends of the last year.
Read More
Drs Raymond Thertulien, Joseph Mikhael on Racial Disparities in Multiple Myeloma Care Access
December 28th 2023In the wake of the 2023 American Society of Hematology Annual Meeting and Exposition, Raymond Thertulien, MD, PhD, of Novant Health, and Joseph Mikhael, MD, MEd, FRCPC, FACP, chief medical officer of the International Myeloma Foundation, discussed health equity research highlights from the meeting and drivers of racial disparities in multiple myeloma outcomes.
Listen
Real-World Study Reveals Key Insights Into DLBCL Treatment Patterns, Outcomes
April 18th 2024A recent study offers valuable insights into the characteristics, treatment patterns, and outcomes of diffuse large B-cell lymphoma (DLBCL) in patients across different lines of therapy, providing a look into the landscape of DLBCL management.
Read More