Affordable Cost-Sharing & Decent Benefits

Keeping the Insurance Industry Accountable to Consumers

Thanks to the Affordable Care Act, insurers can no longer charge higher premiums or deny coverage to people with pre-existing conditions.  Nor can they rescind policies after a serious diagnosis. But just because the worst insurance industry practices are prohibited doesn’t mean there aren’t still issues with the insurance industry. In fact, where there’s money to be made (there is and now more than ever) insurers, nonprofit and for profit, will find other ways to avoid risk or shift cost to unsuspecting consumers.  

Health Access is focused on identifying these unfortunate industry practices and seeking solutions.

  • The proliferation of ‘junk’ or subminimum plans offered by large employers. Health Access supports legislation making limited benefit plans supplemental to comprehensive insurance coverage, closing a loophole in federal law that prevents employees from taking advantage of exchange subsidies, even when their employer offers them junk insurance.
  • Surprise Bills or balance billing: Patients who have health coverage may get surprise bills from physicians when the patient’s health plan refuses to pay. The practice is known as “balance billing.” This places the consumer in the middle of a billing dispute between the health plan and the physician. Patients who do not pay these bills are often aggressively pursued or sent to collections by the physician. The Department of Managed Health Care, in October 2008, made effective new regulations on balance billing that were one step toward protecting consumers against some of these billing disputes between providers and insurance companies.
  • Cost sharing protections. While the ACA has limited financial exposure for consumers, most notably a cap on out-of-pocket obligations such as copays and deductibles, cost-sharing continues to be a major barrier to care for too many consumers. We seek efforts to make out-of-pocket costs manageable, from limiting the co-payment for specialty medications, to having insurers track cost-sharing and do timely reimbursements.

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Health Access Analysis