Tighter Requirements for Insurers in 2015
Tighter Requirements for Insurers in 2015

Late on Friday, the Centers for Medicare and Medicaid Services (CMS) sent a letter to insurers offering plans on the federally-facilitated healthcare.gov outlining new requirements for 2015.  In many areas, the new requirements tighten regulations on insurers and address many consumer complaints.

Chief among the changes were requirements around provider networks. Many folks have complained that insurers have primarily kept premiums low by creating unnecessarily small and restrictive provider networks. Friday’s letter requires that plans provide access to at least 30 percent of “essential community providers” like health centers, children’s hospitals, etc.

The Administration is requiring that all plan offerings also include links to specific information about covered providers and prescription drugs to allow individuals to make more informed decisions. The letter also indicates a more strict review process around cost-sharing provisions for determining if plans discriminate against certain conditions or high-cost patients.

Not surprisingly, this latest move was met with criticism from insurers and the business community, who argued the changes would mean higher costs for everyone. The Administration, however, would surely argue that these changes get to the spirit of the law’s purpose to provide access to health care for all.