Several insurance groups are asking the CMS to allow them to charge higher out-of-pocket costs for grandfathered Affordable Care Act plans to account for drastically rising drug costs.
The Blue Cross and Blue Shield Association requested the agency change the methodology for grandfathered plans' charges to beneficiaries. Currently, the plans can raise or lower their deductibles or maximum out-of-pocket limits by medical inflation plus 15 percentage points. That's calculated using the Consumer Price Index for all urban consumers published by the Labor Department.
But that doesn't properly address healthcare costs, the association said in comments to the CMS.
Instead, the Blues want the CMS to move to a methodology that uses projections on the "average per enrollee private health insurance premiums for the National Health Expenditure Accounts" that the CMS actuary produces.
The CMS asked insurers for information on the challenges that employer and group health plans face in keeping grandfathered status, which had to be established before March 23, 2010. The plans are exempt from meeting certain ACA requirements, such as coverage of essential health benefits.
The number of grandfathered plans has shrunk since the ACA was signed into law. Last year, 20% of employers offering health plans had at least one grandfathered plan, a survey from the Kaiser Family Foundation said.
The American Benefits Council, a group that lobbies for employer-sponsored plans, said in comments that the CMS needs to enable plans to increase prescription drug copays because "prescription drug inflation exceeds medical inflation."'
The council said that the vast majority of its more than 440 members no longer offer grandfathered plans, as employers shift toward high-deductible health plans with health savings accounts.
The Blue Cross and Blue Shield Association, which represents 36 insurers, said that its plans have about 700,000 members covered by grandfathered plans on the individual market.
"Extrapolating this to the total individual market, there are likely over 1 million persons still enrolled in grandfathered individual market coverage," the comments said.
Anecdotally some of the reasons the plans have stuck around is that they are cheaper than plans sold on the ACA exchanges.
The association said any new flexibility given to grandfathered plans in the group market should also apply to individual market plans as well.