Mass. Board Reconsiders Drug Benefit in Low Cost Plans

By | February 9, 2007

The board charged with getting insurers to come up with low-cost health care plans is considering a proposal that would allow insurers to offer plans that don’t include prescription drug coverage.

The goal is to produce health care plans that offer solid coverage but can be afforded by anyone earning more than three times the federal poverty rate — or about $29,400 for an individual.

“We will have a discussion about providing revised specs to providers on which we would expect the new round of bids to be based,” board chairwoman Leslie Kirwan said in an interview with The Associated Press, adding the board has to make sure it isn’t “asking for something that the industry can’t deliver.”

A key sticking point is whether those plans should require prescription drug coverage.

Insurers say drug coverage would drive up monthly premiums beyond the low-cost goals lawmakers envisioned when they approved the state’s landmark health care law last year. Health care advocates say drug coverage should be a key part of any insurance plan.

A staff recommendation released late Wednesday asks the Commonwealth Health Insurance Connector board — charged with turning the law into a reality — to consider letting insurers offer policies without drug coverage while still getting the panel’s official seal of approval.

The plans would still have to meet other requirements, including creating a maximum deductible of $2,000 for individuals and $4,000 for families, covering at least three doctor visits for individuals and six for families, and capping maximum out-of-pocket spending for in-network services at $5,000 for individuals and $10,000 for families.

Policies with lifetime or annual maximums — or maximum benefits per illness or injury — would be banned.

Plans that fail to meet the standards would be denied the board’s seal of approval.

Insurers have said they should be given the freedom to come up with alternative plans that would drive down monthly premiums by trading off levels of coverage, particularly drug coverage.

The goal is to get monthly premiums closer to the $200 mark suggested by former Gov. Mitt Romney.

After the last meeting, the board and Gov. Deval Patrick urged insurers to try to find ways to shave costs.

The move came after members of the board were told that the average price for the new plans could cost about $380 a month.

Kirwan, who also serves as Patrick’ budget chief, said the board has little choice but to take a second look at what constitutes minimum coverage.

“Without revisions to the specs, we couldn’t get meaningful bids,” she said. “We want to be clear about the options and then see how those bids come back.”

Eric Linzer, spokesman for the Massachusetts Association of Health Plans, referred to an earlier statement released by the group that warned against adopting a “one-size-fits all approach” and urged the board to give insurers more latitude in drafting insurance plans.

“If Massachusetts residents are going to be required to purchase coverage, then they should be able to choose the options that best meet their health care needs at a premium they can afford,” association president Marylou Buyse said in the statement.

Under the health care law all state residents are required to have health insurance by July 1 or face tax penalties.

An estimated 160,000 to 200,000 people are uninsured and do not qualify for state-subsidized plans.

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