2018 exchange plans could cover fewer hospitals, doctors, drugs

Insurance companies that sell coverage through the state’s health insurance exchange next year will be allowed to cover fewer hospitals, doctors and prescription drugs under changes the exchange’s board approved Tuesday.

Officials hope those changes could help offset rate increases that would otherwise be required because of the increased price and use of medical care and prescription drugs.

“All the carriers have been saying that these changes will help them offer more competitive plans, so we want to see them do that,” Access Health CT CEO Jim Wadleigh said.

Separately, the board approved changes to plan designs for 2018 that would, in many cases, leave customers with higher out-of-pocket costs. The most popular mid-level silver plan, for example, would see a deductible increase from $4,000 to $5,000 for individual coverage.

It’s not yet clear whether the network and drug coverage changes will translate to lower rates, since insurance companies have not yet proposed rates for plans to sell through the marketplace in 2018. But Paul Lombardo, an actuary at the Connecticut Insurance Department, told the board that allowing insurers to cover fewer providers – and potentially negotiate lower prices with those they cover – could cut premiums by 5 to 10 percent. He also noted that health plan costs for medical services and pharmaceuticals – which take into account both price and members’ use of care – are rising by 8.5 percent to 9.5 percent.

Arielle Levin Becker / CTMirror.org

Shan Jeffreys, Access Health’s director of marketplace strategies, left, and Paul Lombardo, Connecticut Insurance Department actuary

The prospect of having customers face both higher out-of-pocket costs for care and increased premiums led some board members to describe health care costs as unsustainable.

“From a consumer’s perspective, I think we’re way down that path,” board member Paul Philpott said. “I just don’t see how we can continue to do…

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