Report finds most short-term plans don't cover maternity, substance misuse care
- A Kaiser Family Foundation report argues that recent efforts to promote short-term plans could have an adverse effect on the Affordable Care Act-compliant individual market, creating higher premiums for compliant plans and potentially leaving a greater number of people uninsured.
- The expansion of short-term plans, along with the elimination of the individual mandate penalty, could also make it difficult for people who need behavioral health services and substance misuse treatment, which aren't typically covered benefits under those plans.
- The Trump administration’s plans for short-term expansion would primarily impact the middle class, as lower-income people are protected from premium increases through the use of federal subsidies, KFF said.
Last year saw Congress repeal the individual mandate penalty enforced by the ACA and President Donald Trump sign an executive order requesting HHS to expand the availability of short-term health plans. Earlier this year, the administration proposed a regulation that would increase the maximum coverage term of short-term policies from three months to one year.
Short-term plans are not required to comply with federal rules for individual health insurance under the ACA, effectively allowing them to charge more for those with preexisting conditions and to not provide what the ACA deemed essential health benefits.
Both the Alliance of Community Health Plans and America's Health Insurance Plans have bashed CMS' proposal to expand short-term plans. The payer trade groups say the rule would undermine key consumer protections, lead to higher premiums in the individual market and jeopardize market stability.
This KFF report highlights just how insufficient the plans can be for people in need of care. The analysis looked at 24 short-term products offered through eHealth.com and AgileHealthInsurance.com and found 43% do not cover mental health services, 62% do not cover services for substance misuse treatment and 71% do not cover outpatient prescription drugs. None of the plans cover maternity care.
Those services, however, are frequently needed. The U.S. has the worst maternal mortality rate of any developed country, with an estimate 26 deaths for every 100,000 live births. The problem is getting worse in this country while other countries see their maternal mortality rates falling. The U.S. is also in the ravages of an opioid epidemic. The Centers for Disease control and Prevention recently reported the rate of opioid-related deaths rose nearly 30% from 2016 to 2017.
While the KFF analysis found it is "not uncommon" for the most inexpensive short-term policies to be priced at 20% or less of the premium for the most inexpensive ACA-compliant bronze plan, consumers who opt for short-term plans to reduce their monthly premiums could be left with uncovered bills and become "uninsurable" through future short-term plans if they need care.
KFF said the current number of short-term policies in effect is unknown. The data they analyzed showed a number of major cities with 20 or more short-term products available, but also several with five or fewer.
- Kaiser Family Foundation Understanding Short-Term Limited Duration Health Insurance
- Healthcare Dive Trump short-term health plan may spur more ACA exits
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