This article is more than 5 years old. Information may no longer be current.
ACR Warns CMS Against Extending Duration of Short-term Insurance Plans
The American College of Rheumatology has urged CMS to reconsider a proposed rule that would increase the coverage period of Short-Term, Limited-Duration Insurance plans from 3 months to 1 year, arguing the change could weaken customer protections that allow patients with rheumatic diseases to access care.
In a press release, the ACR warned that increasing the duration of short-term plans could make it difficult for some consumers and patients to distinguish such gap coverage from long-term plans that are required to comply with the Affordable Care Act (ACA). According to the ACR, Short-Term, Limited-Duration Insurance plans are not required to include coverage for certain services, including preventive care, rehabilitation, prescription medication coverage and laboratory testing for rheumatology patients with inflammatory arthritis and other conditions.
“While we recognize extending the length of time people can carry short-term insurance may provide some individuals with more gap coverage than previously available, we are concerned patients may sign up for these short-term plans not realizing they don’t offer the benefits they need to successfully manage their chronic conditions,” David Daikh, MD, PhD, president of the ACR, said in the release. “It is crucial that patients with chronic conditions are able to remain on their medications and that insurers do not limit access to required care. Treatment decisions should be left to the provider.”
In addition, the ACR said it is concerned that, even if prescription drug coverage is included, it will be minimal and only cover one drug per class, limiting patients’ ability to access biologic medications they may need.
In its comments to CMS, the ACR recommended rules that require insurers to provide notice to consumers that short-term plans may not cover all of the ACA’s essential health benefits, as well as graphs and tables comparing the plans’ coverage to what the patient would receive under an ACA-compliant plan. The ACR added that insurance companies should be required to provide specific guidance to enrollees regarding prescription and specialty drug coverage.
“The ACR is committed to ensuring that all rheumatic disease patients have access to affordable, quality healthcare, and we look forward to serving as a resource to CMS as it works to finalize this proposed rule,” Daikh said. – by Jason Laday