Although the Affordable Care Act requires insurers to disclose information about the number of people enrolled in their health insurance exchange plans, the number of claims denied and consumers' costs for specific services, the Obama administration said it won't be enforcing that provision.
"We do not intend to enforce the transparency requirements until we provide further guidance," the administration told insurers in a bulletin last week. When asked when the government will implement the transparency requirements, the Centers for Medicare & Medicaid Services spokesman Aaron Albright said, "we expect this will begin after a full year of claims data is available," according to The New York Times.
The delay is largely because insurers and federal officials still need more time to collect and analyze enrollment data.
Insurers are currently providing consumers with a summary of benefits and coverage, which explains how deductibles work and when coverage begins, FierceHealthPayer previously reported. The problem, however, is that different plans have different services that are subject to deductibles.
For example, a Florida Blue plan has seven tiers of prescription drug coverage, three of which are just for generic drugs. So consumers pay $4 for generics that treat high blood pressure, diabetes and other chronic conditions, while consumers must reach the annual deductible before coverage kicks in for other generic medications, The Times noted.
The plan's tiers caused consumers to have many questions about Florida Blue's pharmacy benefits, Jon Urbanek, a senior vice president with the insurer, told The Times. To help address the confusion, Florida Blue opened 18 retail stores where consumers can meet with agents to discuss its policies, FierceHealthPayer previously reported.
To learn more:
- read the New York Times article