America’s Healthy Future Act, which Senate Finance Committee Chairman Max Baucus (D-Mont.) released yesterday, contains numerous provisions aimed at making health care coverage affordable. One of those endeavors is the creation of four benefit categories for the health insurance market: bronze, silver, gold and platinum.
No national standard exists. Baucus’ proposal explains that currently, federal law does not define a minimum creditable coverage (MCC) benefit package for purposes of individual, small group, and other group private health insurance. States have the primary responsibility of regulating the business of insurance and may define what qualifies as MCC. (I discussed some of these state benefit mandates in a previous post and provided a preview of a national benefit standard.)
New categories, standard benefits. The chairman’s proposal provides that no policies (except grandfathered policies) could be issued in the individual or small-employer market that do not comply with one of the four categories. All insurers would have to offer coverage in the silver and gold categories. All plans would be required to provide:
· preventive and primary care services,
· emergency services,
· medical and surgical care,
· physician services,
· outpatient services,
· day surgery and related anesthesia,
· diagnostic imaging and screenings (including x-rays),
· maternity and newborn care,
· pediatric services (including dental and vision care),
· prescription drugs,
· radiation and chemotherapy, and
· mental health and substance abuse services.
Plans could not charge cost-sharing (e.g., deductibles, copayments) for preventive care services, except in cases where value-based insurance design is used. In addition, plans would not be allowed to set lifetime limits on coverage or annual limits on any benefits.
Definition of levels. The bronze benefit package, which would represent MCC, would be equal to the actuarial value of 65 percent with an out-of-pocket limit up to the HSA current law limit ($5,950 for individuals and $11,900 for families in 2010) indexed to the per capita growth in premiums for the insured market as determined by the Secretary of Health and Human Services. (For a refresher on “actuarial equivalence,” see my learned colleague’s previous post.)
The silver benefit package would have an actuarial value of 70 percent with the out-of-pocket limits for MCC.
The gold benefit package would have an actuarial value of 80 percent with the out-of-pocket limits for MCC.
The platinum benefit package would have an actuarial value of 90 percent with the out-of-pocket limits for MCC.
A separate “young invincible” policy would be available for those 25 years or younger. This plan would be a catastrophic-only policy in which the catastrophic coverage level would be set at the HSA current law limit, but prevention benefits would be exempt from the deductible.