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  • Short-Term Insurance Rule Adds More Uncertainty to Care

    As APTA continues to advocate for the maintenance of essential health benefits (EHBs) in insurance offered through Affordable Care Act (ACA) marketplaces, the association and other stakeholders are facing another potential challenge to patient access to care: private insurer short-term, temporary health plans that can skirt many ACA requirements around EHBs, preexisting conditions, and continued coverage.

    Earlier this month, the Department of Health and Human Services (HHS) adopted a final rule on the short-term plans, allowing the policies to provide 1 year of coverage, renewable for up to 3 years. Previously, the plans could only be used for a maximum of 3 months.

    The plans are intended to offer a cheaper insurance alternative than plans available through the ACA (although most individuals who purchase insurance through the ACA marketplaces receive subsidies that lower the out-of-pocket costs). But they are not required to comply with many of the consumer protections included in ACA plans. Instead, the plans are able to deny coverage of a preexisting condition, drop coverage should a customer's health status change, and refuse coverage for services such as mental health, prescription drugs—and, possibly, physical therapy.

    "These plans create more options, but they also create more uncertainty for patients and physical therapists," said Kate Gilliard, APTA regulatory affairs senior specialist. "We're concerned that, perhaps unknowingly, patients who purchase these plans may be moving onto plans that don't cover physical therapy or that offer very limited physical therapy benefits."

    Gilliard said the short-term plans were a hot topic at a recent National Association of Insurance Commissioners (NAIC) conference she attended as a representative of APTA.

    "The plans received mixed reviews from the commissioners," Gilliard said. "Some states openly thanked HHS for allowing more consumer options and for giving states more control over their own markets, but other states criticized the plans for the weaker consumer protections and predicted that the plans will cause prices in the ACA marketplace to rise." According to Gilliard, NAIC attendees described a variety of approaches being taken by states in reaction to the HHS rule, from accepting the provisions as written, to placing shorter time limits on coverage, to banning the plans completely.

    "Many of these states are trying to frame these plans as options that should only be used when consumers are in between major medical plans—like when they are between jobs or waiting for ACA marketplace open enrollment—and not to be relied upon as real, full health insurance," Gilliard said.

    APTA regulatory affairs staff are reviewing the rule to better understand potential impacts to patients and the physical therapy profession. However, the association has already gone on record in support of consistent EHBs and has voiced its opposition to an HHS rule change that allows states to lower the bar on required EHB coverage provisions in so-called "benchmark" plans that set the floor for coverage offered in a state marketplace. Many of the short-term plans are even skimpier than what's being offered through the ACA exchanges, even with the recent benchmark changes.

    "While APTA has always supported the importance of patient choice in health care, we are also committed to advocating for access to needed care and consumer certainty that the care patients receive today will be there tomorrow," said Kara Gainer, APTA's director of regulatory affairs. "Short-term plans offer choice but run the risk of decreasing access and creating uncertainty, and the recent final rule from HHS would appear to make matters worse."

    Comments

    • Weak rebuttal. This is an unfortunate but typical response from what is supposed to be the champions for the PT profession and advocates for those that need our care. I remember hearing how excited we were to be considered a necessary service; that all compliant plans had to allow for PT benefits and no longer would we find out as the patient was filling out their paperwork that their insurance did not cover PT. Once again the tail wags the dog and we fumble around to see how we can possibly make a living providing a service that a payer and an administration sees as expendable.

      Posted by David Rous on 8/15/2018 4:14 PM

    • Let's not mince words. These so-called short-term plans are "junk" with low actuarial value. These are not insurance products intended to "create more options" for purchasers of health insurance but to offer more options to health insurance companies to make money on policies which aren't worth the premiums. What is behind this? The Republican side of our Congressional government has been wanting to eliminate the ACA. Since they have been unable to do this legislatively or legally, they are attempting to kick the legs out from under it by taking away the mandate and enticing younger, healthier people away from it with cheap alternative insurance policies, which, if you look closely, do not cover much for the money spent. I would advise my own son, who is young and has his life in front of him to avoid these non-ACA products and merely risk bankruptcy, if heaven forbid, he has a serious illness. Then, at least he would have MEDICAID, a far better option than these cheap, low actuarial-value insurance products which should be prohibited, as they were in the ACA.

      Posted by Stephen Small on 8/15/2018 4:35 PM

    • Competition is good. Citizens should have the option to purchase a shorter term catastrophic health plan if that is in their best interests. They are also free to choose an ACA plan if that is in their best interests. These ACA plans were forced on the American people. Jonathan Gruber, an ACA architect, in fact stated that the Obama administration had to rely on the economic ignorance of the American people to pass the ACA. Remember, these subsidies for ACA plans come at a huge cost to the working taxpayers! So... bring on the competition!

      Posted by William Meredith on 8/16/2018 8:16 AM

    • I think these plans are great for small business's like myself (solo practice cash based PT) who are stuck in state with only one option for health insurance, the ACA. My policy is $1800.00 per month for catastrophic level of coverage. I end up paying cash for all of my health care because my deductible is 10,000.00 per year which I will never hit. At least now I can get the same coverage for my family at 25% of the cost and use the "extra" money to do what I am already doing which is pay for my healthcare.

      Posted by Jason Avakian on 8/16/2018 3:03 PM

    • I am relieved to see these plans become an option. There are many people like me who would like to retire but we are not able to afford giving up our income, plus pay over $2,000 a month for insurance ( for my spouse and I) with a $7,500 deductible. These short term policies could be the bridge that gets me to Medicare and not break the bank.

      Posted by Beth Schafer on 8/20/2018 8:35 PM

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