AHIP Proposes Expanding Catastrophic Plans, Other ACA Changes

On Wednesday, America's Health Insurance Plans released recommendations designed to boost young adult enrollment in health plans offered through the Affordable Care Act's insurance exchanges and improve the overall consumer experience on the websites, the AP/Sacramento Bee reports.

According to the AP/Bee, a central component of the recommendations calls for the creation of a new option for catastrophic, or "bare-bones," health plans. Such plans, which offer lower monthly premiums but require higher out-of-pocket spending, are offered through the exchanges only to individuals under age 30 and they are not eligible for federal subsidies.

Under the proposal, the new catastrophic plans would be available to consumers of all ages and consumers who select such plans still would be eligible for the tax credits under the law. The plans also would have an annual cap on out-of-pocket costs and would cover preventive services at no cost to consumers.

AHIP said that offering such plans would help boost enrollment among adults ages 18 to 34, whose participation in the exchanges is necessary to help keep premium costs down. According to the AP/Bee, this demographic is under-represented among enrollees in the exchanges.

In addition, AHIP recommended:

• A 30-day transition period for certain individuals who switch insurers or whose physicians no longer participate in their plan's network, allowing those people to keep seeing their physicians at in-network prices;
• Implementing a similar transition policy to prescriptions that are medically necessary; and
• Making it easier for consumers to find out which physicians and hospitals participate in various coverage plans.

According to the AP/Bee, it is "unclear" how the proposals might be received and advanced in Congress, but they could become viable if the GOP drops its efforts to repeal the ACA and focuses on improving it. AHIP's recommendation on the new catastrophic plans also could face opposition from some consumer groups that are advocating for lower out-of-pocket spending costs (Alonso-Zaldivar, AP/Sacramento Bee, 6/11).