Unaffordable in its first version, the CT Health Insurance Exchange Board today voted unanimously to raise deductibles and copays on the standard plans for in-network care, blaming federal regulatory constraints. The new standard plan for the Silver level raises the annual deducible (applicable to hospitals) from $2,500 to $3,000 and annual prescription deductible from $200 to either $400 or $500. The Silver out-of-pocket maximum is $6,250. For the Bronze level, the most likely to have affordable premiums, the standard plan deductible is now $3,250 for everything, including prescriptions and office visits, and people must pay 60% co-insurance on most services after the deductible. (Does this really qualify as insurance anymore?) The out-of-network cost sharing was not changed — $12,500 maximum out-of-pocket in Bronze and $12,000 for Silver. All three consumer members of the advisory committee voted against this proposal. Each insurer is required to offer the Exchange Board-approved standard plan at each metal level. They can also offer one other flexible option that will hopefully be more affordable. However, the Board also voted not to allow the plans to offer a less costly flexible option at the Silver level (it’s a win/lose thing). Some Board members voiced concerns about affordability, but the debate was left to the very end of a 3 hour meeting, after long process and progress updates, leaving little time for a full discussion. Then every Board member voted for the new standard plan.
In other developments, they decided to raise copays for each maternity care visit up to the specialist rate ($45 for most plans). It was unclear why these visits are not primary, preventive care and exempt from co-pays entirely. They also voted to fund the $25 to 30 million cost of the exchange bureaucracy by assessing a fee on the entire small group and individual markets. So people who choose plans outside the exchange will pay higher premiums to pay for the exchange. As large groups won’t have to pay the fees, this will make the disparity in premiums between even worse; small businesses pay 18% higher premiums than large groups now on average. The Exchange is also seeking to gain “access” to DOL and DMV data for eligibility verification – raising privacy and security concerns about sensitive income and other information which may not be limited just to Exchange applicants. And the Board gained a new member – again with only insurance industry experience.