Some ACA Exchange Plans Cover PCP Visits With No Cost-Sharing
Health insurers in several markets are offering exchange plans that cover visits to in-network primary care physicians with no cost-sharing requirements, Kaiser Health News reports.
According to KHN, consumers with such plans can visit in-network PCPs without having to pay:
- Coinsurance fees;
- Copayments; or
The no-cost visits are provided in addition to various preventive services insurers must cover without cost-sharing under the Affordable Care Act. The no-cost visits are available "in a limited number of" exchange plans in certain areas.
According to KHN, some insurers have begun offering the additional no-cost services after reports that many U.S. residents have not used coverage they purchased through the exchanges because of the plans' high cost-sharing requirements. Such plans are commonly among the lowest-priced coverage options available in many markets in which they are offered, according to a KHN review.
Insurers say they hope that promoting PCP visits will benefit enrollees, as well as the companies' bottom lines, by detecting members' health issues earlier, when treatment is often easier and less costly.
Health policy experts say the approach could help insurers to attract younger, healthier consumers who do not have relationships with PCPs.
Katherine Hempstead, director of insurance coverage at the Robert Wood Johnson Foundation, said, "Consumers should find this very appealing," adding, "People are not going to grouse as much about cost-sharing later if they are getting something free first."
Consumer advocates have supported the efforts, noting that consumers when selecting coverage should look at the plans' benefits in conjunction with premium costs.
Lydia Mitts, a senior policy analyst at Families USA, said, "It's a smart move to reduce financial barriers to basic outpatient care to help patients manage their health." She added, "I hope other health plans will realize removing financial barriers to primary care doctors is a smart direction for patients and for the plans" (Galewitz, Kaiser Health News, 1/4).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.