There had been uncertainty about whether the health centers, which receive federal funding and serve 22 million Americans at 9,000 sites, were allowed to offer sliding-scale fees to privately insured patients. Last week, HHS released guidance clarifying that the centers can offer these reduced fees to patients with incomes under 200% of poverty.
Of the 7.3 million people who paid for coverage on the exchanges for 2014, from 12% to 22% selected bronze plans, which feature deductibles as high as $5,500 a person.
People with incomes of up to 250% of the federal poverty level who buy silver plans qualify for cost-sharing subsidies that reduce their out-of-pocket costs for care. But purchasers of bronze plans do not.
“Some people with these plans are reluctant to get healthcare at all,” said Deb Polun, director of government affairs at the Community Health Center Association of Connecticut. “Those who do go to a federally qualified health center are typically still in their deductible window, and therefore they are essentially uninsured as far as the (health center) is concerned.”
During the coming 2015 open enroll-ment period, enrollment workers need to raise awareness among lower-income consumers that there are serious downsides to picking a plan based on lower premium alone, said Stephen Davidson, a Boston University health policy professor.
“Many people do not understand the cost-sharing element of their policy and are surprised the first time they go for services and find they are not covered because the deductible has not been met,” he said. “Something to watch in the new benefit year is the extent to which those folks switch plans.”
Follow Virgil Dickson on Twitter: @MHVDickson
