A week after the Obama administration heeded insurers' pleas to put in place tougher rules for special enrollment periods, the administration retreated on a plan to standardize plans available through the Patient Protection and Affordable Care Act (PPACA) federal marketplace.
In November, the Centers for Medicare and Medicaid Services had proposed standardizing plan offerings, so that all plans for different levels of service (gold, silver, bronze) would have the same deductible. However, the standardization plan was not included in the final rule released by CMS on Monday.
Nor did the final rule include another proposal fiercely opposed by insurers, which would have set standards for the number of in-network providers that each plan must include within a certain distance from the beneficiary. The administration floated the proposal in response to complaints from consumers and some providers about "narrow networks" that make it hard for some to find nearby physicians and specialists that are covered by their policy.
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A number of states that run their own PPACA marketplaces have already put in place "standardized" benefit designs. California's exchange, for instance, requires participating insurers to offer at least one plan with "standardized" benefits and costs. Still, insurers can offer alternative benefit designs in addition.
Other marketplaces with such rules include those run by New York, Connecticut, Massachusetts, Vermont, Oregon, and the District of Columbia.
Although the administration stopped short of mandating standardized plans, it is nevertheless going to formulate a set of standards that insurers can choose to abide by. The idea is to develop common benefit designs that consumers will become familiar with and will be able to find in all markets.
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