A year from now, consumers shopping for insurance on HealthCare.gov may be happy with some new plan choices and better protections for 2017. Earlier this month, the federal government released new proposed requirements for plans sold on the health insurance marketplaces. We applaud the government for encouraging insurers to sell “standardized plan” designs that cover more health care services before consumers meet their deductibles. But we urge the government to go further.
In November, the National Association of Insurance Commissioners (NAIC), the organization composed of insurance regulators from every state in the nation, will finalize a model law to help states ensure that consumers can get access to the right health care, at the right time, without unreasonable delay. Dubbed the Network Adequacy Model Act, this draft bill is designed to be used by any state to enact provider access standards for private health insurance plans.
Accurate health plan provider directories are critical to ensuring that coverage works for consumers. Health plans and policymakers can take steps to reduce the prevalence of inaccuracies in provider directories.
On May 26, the Centers for Medicaid and Medicare Services (CMS) released long-awaited proposed rule that seek to modernize the regulatory framework governing Medicaid managed care plans. The proposed rule aims to increase efficiency in the managed care program for providers, enrollees, and health plans, while maintaining consumer protections.
This checklist is designed to help advocates and consumers understand who makes decisions about private insurance in their states. It suggests questions to ask the insurance department, state legislators, and others.