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HHS Final Rule Expands Patient Access to Short-Term Health Plans

Expanding duration of short-term health plans will expand patient access to the healthcare coverage option.

hhs patient access short term health plan

By Sara Heath

- The Department of Health & Human Services (HHS) has issued a final rule expanding short-term health plans that will improve patient access to healthcare coverage, according to the agency.

The final rule allows for the sale of short-term health insurance plans that span longer than the previous three-month maximum. Now, short-term plans can span an initial period of less than 12 months and can be extended for 36 months at maximum. This will make short-term health plans easier and more affordable for patients to access, HHS says.

“Under the Affordable Care Act, Americans have seen insurance premiums rise and choices dwindle,” HHS Secretary Alex Azar said in a statement. “President Trump is bringing more affordable insurance options back to the market, including through allowing the renewal of short-term plans. These plans aren’t for everyone, but they can provide a much more affordable option for millions of the forgotten men and women left out by the current system.”

Too few patients have been enrolling for healthcare via the individual market, HHS said, likely because of limited subsidized access to the exchange. In 2017, the number of people accessing subsidized care via the individual exchange decreased by 20 percent.

During that period, premiums rose by 21 percent, HHS reported. In Q4 of 2016, the average monthly premium for an individual beneficiary for a short-term, limited-duration plan was $124, compared to nearly $400 for an unsubsidized individual market plan.

Short-term plans are not beholden to federal regulations for health payer coverage, HHS noted. However, they are reportedly a viable option for beneficiaries who are between insurance coverage – an individual transitioning jobs or a student taking time off from school, for example.

“We continue to see a crisis of affordability in the individual insurance market, especially for those who don’t qualify for large subsidies,” noted CMS Administrator Seema Verma. “This final rule opens the door to new, more affordable coverage options for millions of middle-class Americans who have been priced out of ACA plans.”

Critics of the final rule point out that short-term, limited-duration plans roll back the patient protections issued under the Affordable Care Act. Because these plans will not be held to federal regulations, they can exclude patients with pre-existing conditions or deny certain types of coverage that are protected in ACA-approved health plans.

“The broader availability and longer duration of slimmed-down policies that do not provide comprehensive coverage has the potential to harm consumers, both by making comprehensive coverage more expensive and by leaving some consumers unaware of the risks of these policies,” said Senator Ron Wyden in a statement to Politico.

Justine Handelman, senior vice president for policy and representation at the Blue Cross Blue Shield Association (BCBSA), issued a separate statement prior to the rule’s finalization saying it has the “potential to harm consumers” who do not have adequate information about the short-term plans.

“Health insurance should be available and affordable for everyone, regardless of their health status. The broader availability and longer duration of slimmed-down policies that do not provide comprehensive coverage has the potential to harm consumers, both by making comprehensive coverage more expensive and by leaving some consumers unaware of the risks of these policies,” Handelman said in a statement to The Hill.

The final rule goes into effect in 60 days, prior to the open enrollment period for the ACA.

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