Blog - Affordable Care Act – 2017

Affordable Care Act – 2017

Affordable Care Act – 2017

Small business owners, employees and consumers are struggling to understand the coverage, networks, and costs in the new year. Below are the latest guidelines and three changes to coverage in 2017.

Three Affordable Care Act Coverage Changes in 2017

Under the final 2016 rule, three Affordable Care Act changes will start in 2017 include:

– Increased Information About Provider Networks
– Out-of-network Providers
– Out-of-pocket Costs

Details Of Three Affordable Care Act changes expected to come in 2017.

Increased access to information about the size of the insurers’ network of doctors and hospitals.

When it comes to selecting a health plan, most consumers primarily look at the cost of the plan and whether their doctor or hospital is in the plan’s network. And yet, finding accurate information about the network of providers has been a big complaint.

Under the new rules:

– Insurers would be required to give consumers 30-days’ notice when a provider is being removed from the network, and continue to provide coverage for that provider for up to 90 days for patients in active treatment.

– The Marketplaces will note the relative breadth of each plan’s network with three size designations – basic, standard, and broad.

– Reduce “surprise” medical bills from out-of-network providers.

A common complaint from patients is receiving a “surprise” bill from an out-of-network provider – especially when the patient thought the provider was in-network.
In the new guidelines, there is a small change to help reduce these surprise bills. Under the new rule:

– Amounts paid by consumers for ancillary care – such as anesthesiology or radiology – will be required to count toward a patient’s annual out-of-pocket maximum. As KHN notes, this is 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.

– The new rule, however, only applies in cases where the insurer has not given patients proper notice (generally 48 hours) that they might receive care and bills from such out-of-network providers.

– Standardize consumers’ out-of-pocket costs.

Lastly, the new rule aims to make comparison shopping easier.
Under the final rule, the administration is requesting that next year (2017) insurers voluntarily offer plans with a standard set of coverage costs, such as standard deductibles and co-payments. The idea here is that consumers will better understand the out-of-pocket costs associated with a plan.

As KHN notes, some state Marketplaces have already adopted standardized plans, however with this change being voluntary, and controversial with insurers, it may not have a large impact on consumers.

Conclusion

The recent guidelines by the administration aim to help consumers make more informed decisions when purchasing health insurance coverage this year.

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