Proposed Health Coverage Transparency Rule

A new transparency rule is coming, pushed forward by the current administration. It is focused on your health insurance, and how much information is revealed to you.

With health insurance, you definitely don’t want information hidden, and this goes double for fees or anything that’ll cost you money. For the most part, insurance agents work hard to make sure you’re well-informed to make decisions regarding your policy, but they can only say so much.

people sitting at a table talking about the transparency rule
Changes are coming to teams from insurance companies to hospitals. Everyone will have to be on board.

What the Rule Will Do

If it goes through as proposed, the rule will change the way prices are available, thus creating a better environment for people to comparison-shop for their medical work. Under this rule, both group and individual insurance markets will have to change the administration of their information. This will affect three things:

  1. Give cost-sharing information to enrolled individuals online or in paper form. Online information will be accessed through a tool on company websites.
  2. Disperse both in-network and out-of-network negotiated rates plus allowed amounts. These will be available in two machine-readable files.
  3. Insurers could access “shared savings” by offering lower-cost plans and claiming the credit their enrollee’s saved by choosing the cheaper provider.

Under this rule, the disclosed information will come with seven different items:

  1. Estimated cost-sharing liability An averaged amount for the patient’s payment, not including premiums or otherwise. It will show cost-sharing savings or be eligible for their market plans. 
  2. Accumulated amounts– The amounts already paid (deductibles, out-of-pocket maximums, etc.) 
  3. Negotiated rates– The payments (and how much) made by the insurers, third-parties, or otherwise to in-network providers
  4. Out-of-network allowed amounts– The maximum amount your plan/insurer covers for a specified medical expense if it’s out-of-network
  5. Bundled payment for listed items/services- A list of covered items/services for the cost-sharing estimate. Helps with your payment 
  6. Coverage Prerequisites- A note for enrollees to see what requirements they need to meet before their expenses will be covered. Ex. step therapy
  7. Disclosure notice– Basically anything that needs to be told to the person. Ex. an item not shown in an earlier document, differing final prices, etc.

    man teaching people about new transparency rule
    We’ll have to learn more about our own insurance with this rule. Better visibility means more choice for the policyholder.

The outcome everyone is hoping for is that with visibility comes competition. Hospitals will have to compete with others for their price list, hopefully driving prices down. However, the hospitals fighting this rule believe that insurers will covertly come together to rig the prices. They also aren’t happy about an increase in administrative costs. Unfortunately, we won’t be seeing any changes until 2021 with most hospitals asking for extra time to prepare for the changes. We remain hopeful that this transparency rule will bring positive changes.

If you are looking to get more coverage for your company, EZ.Insure offers solutions. Your agent will answer any questions you have, compare the plans available to you, and even sign you up when you are ready, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing, or calling 888-998-2027. EZ.Insure makes the entire process simple, easy, and quick.

Trump Promises To Protect Pre-Existing Conditions

Over the years, President Trump has been slowly picking away at Obamacare, also known as the Affordable Care Act. But there has been one section of the ACA that he intends to keep, which is the pre-existing conditions clause. Trump recently stated he was going to “totally protect people with pre-existing conditions.” Despite the Trump Administration putting the provision in jeopardy, Trump is stating he backs it and that Democrats do not.

Trump promises to protect and cover pre-existing conditions, even after the ACA is gone.
Trump promises to protect and cover pre-existing conditions, even after the ACA is gone.

The controversy all began when Trump was running for presidency. One of his promises was to get rid of Obamacare, and so far he has kept that promise. Over the years, he has gotten rid of the individual mandate. This mandate stated that people must get health insurance or they will face a penalty. Due to getting rid of this mandate, many states have challenged the ACA’s constitutionality in a lawsuit this past February. These states are saying that since the mandate is unconstitutional, then the entire health care is also.

The Promise

Throughout the dismantling of the ACA, Trump is fighting to protect people with pre-existing conditions. He wants to make sure that they are still able to get health insurance, and will not be rejected or pay more because of the conditions. This is all came about as midterm elections were approaching, and he was urging people to vote Republican. In his tweet he stated that Republicans will back those with pre-existing conditions, and that Democrats will not, so “vote Republican.”

Trump administration officials said they will allow states to use federal subsidies to pay for health plans that don’t cover pre-existing conditions. Republicans all over the U.S. back what Trump has said about pre-existing conditions.

Make sure you plan ahead so that you are covered.
Make sure you plan ahead so that you are covered. Look into a short-term plan, and if it will work for you.

However, there are many doubts if this will actually hold true. A lot of people are skeptical about the pre-existing provision, especially after the midterm elections. Many see this as an attempt to get people to support Trump. The fact is that premiums may be high for those with pre-existing conditions, and not necessarily protect them.

Short-term plans are being expanded in hopes that people will go for them, which does not offer comprehensive plans. This means they may not necessarily cover pre-existing conditions. But if Trump does truly stand behind protecting pre-existing conditions, he can take some steps to ensure it will be be protected, which we have yet to see.

Once the lawsuit between the states and the government to get rid of the ACA is over, only then will we know what will happen with pre-existing conditions. This can cost a lot of people looking for health insurance a lot of money, and even possibly be denied coverage.