Many consumers will have a new option for Healthcare.gov’s fourth open-enrollment period. The website is adding standardized health plans that cover basic services without a deductible. The Obama administration said in a statement that the new standardized options are meant to ensure that “enrollees receive some upfront value for their premium dollars.”
The new options will be identified on HealthCare.gov with the label “Simple Choice.” Federal officials say the new option will simplify shopping under the Affordable Care Act. According to the federal website, “All Simple Choice plans in the same category have exactly the same core benefits, deductibles and co-payments.”
The standardized version of a midlevel silver plan has primary care, specialty care, outpatient mental health services and prescription drug coverage that is exempt from the $3,500 deductible. Co-payments for a silver plan would be $30 for a primary care visit, $65 for a specialist visit, $15 for a generic prescription drug, $50 for preferred brand-name drugs and $100 for nonpreferred brand-name drugs. For the lower-income families, the charges would be lower.
Many of the health plans currently on the marketplace come with deductibles that cost consumers thousands of dollars. Consumers have complained that the high deductibles mean they are getting little benefit beyond coverage for catastrophic medical issues and accidents. But having coverage is now mandated by the government. Next year, people without health insurance face possible tax penalties that could exceed $700 a person.
The new plans may still be expensive. The federal government does not limit premiums for the standardized options, which are still regulated by state insurance commissioners in most cases. Insurers also still have discretion to vary many of the features of the policies that would not be standardized. Consumer advocates are open to the idea, but insurers are pushing back against the standardized plans.
Keeping the Affordable Care Act affordable for consumers has been a struggle for the Obama administration. Many plans available for 2017 will have rate increases of 25 percent or more over last year’s prices. Aetna, UnitedHealth and other insurers have removed their options from the public marketplace after losing tens of millions of dollars in the exchanges. The Affordable Care Act’s health insurance marketplace opens in two weeks and open enrollment runs through Jan. 31.
