Proposals expected to be announced as part of the administration's American Patients First plan, include various changes to Medicare’s prescription drug program, such as protecting beneficiaries from catastrophic costs through an out-of-pocket maximum, and requiring plans to share a minimum portion of drug rebates with patients.
Marketplace Health Insurance Changes Likely to Impede Patients’ Access to Insurance; Increase Consumer Costs
Washington, D.C.--Today the Centers for Medicare and Medicaid Services (CMS) issued a final rule regarding changes to marketplace health insurance plans. The rule, intended to help stabilize insurance markets created by the Affordable Care Act, potentially restricts patients’ access to special enrollment periods (SEPs), reduces the number of Essential Community Providers with which plans must contract and lessens the actuarial value of some plans sold in the marketplace—leaving patients vulnerable to higher out-of-pocket costs.
ACS CAN submitted detailed comments to CMS March 7, when the rule was first proposed. The final rule, which is largely unchanged from the proposed version, did not address the concerns raised by ACS CAN regarding potential impact on those with a history of cancer.
A statement from Chris Hansen, ACS CAN president, follows:
“ACS CAN supports a strong marketplace and welcomes efforts to strengthen it. However, any improvement efforts should not jeopardize access to meaningful health insurance for cancer patients, survivors and those at risk for the disease.
“Under the new rule, patients trying to enroll in insurance plans outside of the annual enrollment period will face strict documentation requirements. These requirements, while intended to prevent people from inappropriately enrolling in plans, have the potential to delay or interrupt cancer patients’ care. Such patients often face extenuating circumstances due to the nature of their disease and treatment, like job loss or relocation, and rely on special enrollment periods to swiftly transition coverage without interrupting care.
“Moreover, weakening the Essential Community Provider standards and lessening the actuarial value of plans, will likely shift additional costs to patients through higher or more frequent out-of-network charges for various medical services and through diminishing the value of advanced premium tax credits for those who qualify.
“We will closely monitor these alterations to ensure cancer patients’ access to appropriate, meaningful and affordable care is protected. We understand changes are necessary to maintain and improve a functional marketplace and welcome opportunities to work with Congress and the administration to strengthen the exchanges and improve patient access.”