Six ways CT’s Obamacare exchange insurance will change next year

Yes, the enrollment period for plans sold by Connecticut’s health insurance exchange ended less than two months ago.

But the marketplace, Access Health CT, and health insurance companies are already working on next year’s plan offerings, which will replace the plans customers have now.

There will be some significant changes.

One thing that still hasn’t been determined: What the plans will cost. Insurers must submit rate proposals in the coming weeks for review and approval by the Connecticut Insurance Department.

Here’s a look at what’s changing on the exchange for 2015. (For details on how each plan is changing, click here.)

1. People will be able to shop for adult dental care on the exchange.

Health plans sold through the exchange doesn’t cover dental care for adults. People looking for dental insurance through the exchange for this year were routed to the website of Anthem Blue Cross and Blue Shield, which sells standalone dental policies that meet the exchange’s criteria for coverage.

That’s slated to change. The exchange expects to have an operational market for standalone dental plans for 2015 coverage.

Although they don’t cover adult dental care, the health plans sold through Access Health already cover dental care for children up to 19, and that’s not expected to change.

2. There will be stricter requirements for the size and make-up of health plans’ provider networks.

Across the country, one strategy insurance companies have used to keep their plan costs down is to include smaller-than-usual numbers of doctors, hospitals and health care providers in their exchange plan networks. Connecticut has limited the degree to which insurers could do that, requiring this year that insurers' exchange networks be “substantially similar” to the network used in their largest plan sold outside the exchange. Still, the networks used by the two largest insurers on the exchange’s individual market cover fewer health care providers than the companies’ other plans, and that’s led to some confusion and complaints among patients.

Connecticut's exchange is tightening its network requirements for 2015. It will require that insurers’ exchange networks cover at least 85 percent of the health care providers and facilities as their plans sold outside the exchange. (Currently, the requirement is 80 percent for exchange plans, as long as they have at least 10,000 providers and 750 facilities.) And the exchange is going to create a new set of “reasonable access” standards based on the geographic distribution of providers and how quickly they will see new patients.

What does that mean for prices? One insurance official said expanding the networks, while good public policy, could mean higher prices.

“There are tradeoffs for the sizes of network,” Deputy Insurance Commissioner Anne Melissa Dowling said during a recent exchange board meeting. “The filings we’ve had have seen substantial discounts for narrower networks, and other states are seeing some real popularity for those choices.”

3. Customers will likely have more health plan choices.

In 2015, insurers that sell plans through the exchange will be required to offer more standardized choices -- that is, plans that follow the same benefit design, allowing shoppers to more easily compare their options. Insurance companies will also have the option of offering more plans of their own design.

This year, three insurance companies offer plans through the individual exchange (Anthem Blue Cross and Blue Shield, ConnectiCare Benefits, and HealthyCT). Most customers had a choice of 16 different plans, organized by metals: bronze, silver and gold. Bronze plans have the lowest premiums but the highest out-of-pocket costs for people who get care. Gold plans have the highest premiums but cover the largest share of members’ medical expenses.

Next year, each insurer that sells plans through the exchange will be required to sell at least four standardized plans: one gold, one silver and two bronzes (up from one this year). They will also have the option of offering up to 12 nonstandard plans, up from eight this year.

Insurers also have the option of offering platinum plans that offer higher-level coverage than the gold plans. No insurers offered platinum plans this year.

4. Every insurer on the exchange will have to offer a high-deductible plan with a health savings account.

High-deductible plans with health savings accounts are increasingly common in employer-sponsored coverage, and exchange officials say they’re also likely to appeal to people buying coverage for themselves, particularly the coveted “young invincibles” that health plans seek to balance out the costs of older, sicker members.

The plans tend to have comparatively low premiums, but high out-of-pocket costs. With the exception of some preventive services, members would have to pay the full cost of all care they receive until they reach the deductible, which is set at $4,600 for individuals and $9,200 for families. People can set up health savings accounts that allow them to save tax-free dollars to use to pay for medical care.

In 2015, every insurer offering coverage through the individual exchange will have to offer a standard bronze plan with a health savings account.

The new requirement was controversial among members of the exchange’s board. Some members said they worried that customers won’t have the education or understanding to know what they’re buying and could end up selecting high-deductible plans without realizing how much they’d have to spend out-of-pocket. Board members want to monitor the plans and provide education to potential customers.

There are plans with health savings accounts currently sold on the exchange, but they’re nonstandard plans.

5. The deductibles are going up in the cheapest plans. But that could keep the premiums down.

For most customers, bronze plans offer the cheapest premiums but the highest out-of-pocket costs. This year’s standard bronze plan has a $3,250 deductible, meaning that members have to spend that much on medical care before the plan begins paying for most medical services.

That deductible will rise next year to $5,000. A separate standard bronze plan, which comes with a health savings account, will have a $4,600 deductible. (Those figures are for individuals. For family coverage, the deductibles are doubled.)

But there are tradeoffs: the higher deductibles could mean lower premiums. And one of the two standard plans was redesigned to help members get some medical care at lower costs.

The plan design changes could translate to reductions of about 3 percent in premium prices, according to actuaries consulting for the exchange. That doesn’t mean that the actual premiums will drop, because the actuaries didn’t take into account other factors that increase insurance costs, such as rising health care prices or insurers’ projections that members will need more medical care. But the change in benefit design means any price increases might be lower than they otherwise would be, if the actuaries’ projections are correct.

In addition, the bronze plan with the $5,000 deductible has two changes aimed at ensuring that people could get some basic services without having to meet the deductible.

In 2015, members of that plan would be allowed three primary care office visits and three mental health office visits without the deductible applying. People would instead pay a $40 copay for each of those visits.

Members would also get generic drugs for a $5 copay, regardless of whether they reached the deductible or not. In the 2014 plan, they must pay the full price until hitting the deductible.

6. Deductibles in the midlevel plan are going down, but the maximum out-of-pocket costs are going up.

The exchange’s standard silver plan will have a $2,600 deductible next year for individuals, down from $3,000 this year. In addition, the plan’s prescription drug deductible is dropping significantly, from $400 to $25. (For family plans, double those numbers.)

But the limit on members’ maximum out-of-pocket costs is rising. In 2015, individuals’ costs will be capped at $6,600, up from $6,250 this year. For families, the limit will be $13,200, up from $12,500. (Money spent on premiums don’t count toward those limits.)

In addition, the copays for specialist visits are rising from $45 to $50.

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About Arielle Levin Becker

Arielle Levin Becker was a finalist in 2009 for the prestigious Livingston Award for Young Journalists, a recipient of a Knight Science Journalism Fellowship and the third-place winner in 2013 for an in-depth piece on home caretakers from the National Association of Health Journalists. Arielle previously worked for The Hartford Courant, most recently as its health reporter. She also has covered education and municipal beats for The Courant and for the Home News Tribune of East Brunswick, N.J. She is a 2004 graduate of Yale University.

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