Simple Choice plans in the federally-facilitated exchange

standardized plansLast month, I wrote about the standardized plans that will be optional for insurers to offer on Healthcare.gov this fall. I noted that standardized plans do not signal the end of HSA-qualified health insurance, and outlined the basic details surrounding standardized plans.

The standardized plan designs that HHS finalized in the 2017 Benefit and Payment Parameters do not apply in Colorado. They’re for the federally-facilitated marketplace, and Connect for Health Colorado will have to make its own decisions about whether or not to introduce standardized plans (the issue is currently under consideration)

In late April, Healthcare.gov CEO, Kevin Counihan and CMS Principal Deputy Administrator, Dr. Patrick Conway wrote a post for the CMS Blog about the standardized plans, which have been dubbed “Simple Choice” plans. They note that the plans will “display prominently” when consumers are comparing plan options, and the expectation is that it will be easier for shoppers to compare apples to apples when they shop among the standardized plan designs.

When I read the post on CMS Blog, a few things stood out to me, making me wonder at first whether the Simple Choice plans were actually the same thing as the standardized plan designs that has been finalized in February in the 2017 Benefit and Payment Parameters.

  • The blog post says that Simple Choice plans will be available at all four metal levels, but HHS did not create a standardized plan design at the platinum level, due to low consumer demand for platinum plans and the fact that platinum plans are not available in all areas – many carriers don’t offer them at all.
  • The blog post also says that “for certain services, for instance a primary care appointment, a consumer would pay the same amount in any Simple Choice plan, regardless of the metal tier.” But the standardized plan designs that HHS finalized have different primary care copays for each metal level ($45 for bronze – up to the first three visits in the year; $30 for silver – with lower copays for silver plan enrollees who qualify for cost-sharing subsidies; $20 for gold).

I contacted CMS about this issue last week, asking about the discrepancies between what’s in the final regulations from HHS, versus what’s in the post on the CMS Blog. CMS confirmed that the Simple Choice plans are indeed the name they’re given to the standardized plans that were finalized by HHS. The CMS press office noted that they would make changes to the blog post to bring it into line with the official standardized plan designs.

If you’re curious about the specific details for the Simple Choice plans, everything is laid out in the Benefit and Payment Parameters [see Section G, Part 156 (1)]. CMS is still working out the details of how they’re going to visually differentiate the Simple Choice plans from everything else, and we don’t yet know how common the Simple Choice plans will be among carrier offerings for 2017. And again, none of this applies in Colorado, since the state runs its own exchange.

Stay tuned…

About Louise Norris

Louise Norris has been writing about health insurance and healthcare reform since 2006. In addition to the Colorado Health Insurance Insider, she also writes for healthinsurance.org, medicareresources.org, Verywell, Spark by ADP, and Boost by ADP, and Gusto. Follow on twitter and facebook.

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