3 Obamacare Changes to Expect Next Year
By Julie Appleby
Tue, Mar 15 2016
Health insurance isn’t simple. Neither are government regulations. Put the two together and things can get confusing fast.
So it’s not surprising that federal regulators took a stab at making things a bit more straightforward for consumers in new rules unveiled in late February and published Tuesday in the Federal Register. Because those rules are part of a 530-page, dizzying array of changes set for next year and beyond, here are three specific changes finalized by the Department of Health and Human Services that affect consumers who buy their own health insurance in one of the 38 states using the online federal insurance exchange.
1) Consumers could have access to more information about the size of the insurers’ network of doctors and hospitals.
Most consumers care about two things: the cost of the plan and whether their doctor or hospital is in the plan’s network. The new rules would require insurers to give consumers 30-days’ notice when a provider is being removed from the network. They must also continue to provide coverage for that provider for up to 90 days for patients in active treatment, such as those getting chemotherapy or for women in the later stages of pregnancy — unless the provider is being dropped for cause. Consumers will also see another change: The relative breadth of each plan’s network will be noted with three size designations, which are roughly equal to basic, standard and broad.
2) Consumers could be given slightly more warning about “surprise” medical bills from out-of-network providers.
One of the most common complaints from consumers — even before the federal health law passed — concerns bills they get from out-of-network providers. Such bills can hit consumers even when they go to facilities that are in an insurer’s network because not all of the doctors and other medical staff in those facilities are part of the network. The new rules make a small change, requiring that amounts paid by consumers for ancillary care — such as anesthesiology or radiology — count toward their annual out-of-pocket maximum. That’s important because once a patient hits that out-of-pocket maximum, the insurer is responsible for all in-network medical costs for the rest of the year. But the new rule only applies in cases where the insurer hasn’t warned patients — generally at least 48 hours before the hospitalization or procedure — that they might receive care and bills from such out-of-network providers. Consumer advocates say insurers will simply issue form letters to as many patients as they can to avoid the rule, while insurers complain the rule doesn’t get at the heart of the matter: the high charges they say are set by out-of-network providers.