Faced with growing criticism that Obamacare offers little choice of doctors, the Obama administration is toying with implementing new requirements for healthcare plans.
The Centers for Medicare and Medicaid Services issued a proposed rule Friday offering improvements to Obamacare’s marketplaces. If finalized, the rule’s improvements would affect 2017 Obamacare plans, not the 2016 plans currently offered on the exchanges.
But one expert says the push to expand doctor choice in plans could affect some premiums.
The rule asks states to establish a standard for doctor networks on all health plans on the exchanges. Those standards would have to meet minimum criteria from the agency, which it has not established.
The agency is looking at other ways to address doctor networks. One such measure is whether designating a plan with a strong network, such as having a broad number of doctors or health facilities to choose from, could affect consumer shopping for a new health plan.
The proposals come as Obamacare enrollees in some states don’t have a lot of options when choosing a doctor. A July study from the research firm Avalere Health found that Obamacare insurance exchanges offer 34 percent fewer providers than average plans offered outside the exchanges.
However, narrow doctor networks was one of the tools that insurers used to keep premiums down, said Elizabeth Carpenter, vice president at the health research firm Avalere Health. Whether the provisions would lead to higher premiums depends on the plan.
“The impact of network adequacy on premiums depends on a plan’s current network design and how they may or may not to lower premiums,” Carpenter told the Washington Examiner. “Some plans new network adequacy requirements may require changes and they may already be in compliance.”
The agency also wants to address sticker shock in the healthcare plans by addressing out-of-pocket expenses. It wants to require health plans to count certain out-of-pocket expenses or unexpected out-of-network expenses toward a policyholders’ maximum amount of out-of-pocket expenses, CMS said.
An out-of-pocket maximum is the maximum amount you will pay for healthcare throughout the year. It includes a deductible and co-pays.
Say a patient gets surgery at an in-network facility but the surgeon isn’t in network. The payment to the anesthesiologist would count toward the out-of-pocket maximum.
Currently it would not be counted, the agency said.
The proposed rule also seeks to be more accurate on subsidies it pays out to insurers under the law’s risk adjustment formula. Obamacare is supposed to pay insurers to compensate for taking on too much risk, but such payments have been inaccurate at times.
Overall, Carpenter noted that the rule appears to prioritize the consumer experience and clarity in choices.
The agency is seeking public comment on the proposed rule until Dec. 21.
