Narrow Networks and High Cost-Sharing Among Concerns Raised by New Report on Affordable Care Act from The Leukemia & Lymphoma Society

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Jan 15, 2014, 02:20 ET

WHITE PLAINS, N.Y., Jan. 15, 2014 /PRNewswire/ -- Many qualified health plans participating in the new insurance exchanges have limited access to National Cancer Institute (NCI) designated cancer or transplant centers, and would impose high out-of-pocket costs for patients purchasing at the silver and bronze levels, according to a report commissioned by The Leukemia & Lymphoma Society (LLS).

The report, 2014 Individual Exchange Policies in Four States: An Early Look for Patients with Blood Cancers, prepared by Milliman, Inc., provides an early look at the 2014 individual benefit designs, coverage benefits and premiums for policies sold on four state health insurance exchanges - California, New York, Florida and Texas. It looks at items of particular concern to people with blood cancers – which drugs are covered and whether cancer centers and transplant centers designated by the NCI are included as "in network" facilities.

The creation of these exchanges was a mandate of the Patient Protection and Affordable Care Act. Through these marketplaces, individuals can purchase health insurance, and individuals meeting certain income requirements are eligible for subsidies to help offset insurance premiums and out-of-pocket payments.

"The Leukemia & Lymphoma Society exists to find cures and ensure access to treatments for all blood cancer patients," said Mark Velleca, M.D., Ph.D., chief policy and advocacy officer of LLS. "Therefore, while many new rules under ACA make obtaining insurance easier for people with blood cancers, such as prohibiting companies from turning away patients with preexisting conditions and eliminating lifetime coverage limitations, the Milliman report identifies several areas of concern that we want cancer patients to be aware of, and policymakers to address."

Network adequacy: The data show that many specialty providers and hospitals that cancer patients rely upon are largely left out of the new health insurance exchange plans. Since it is unlikely that any out-of-network expenses will count toward a patient's out-of-pocket maximum, cancer patients could rack up thousands of dollars of medical expenses and never reach their out-of-pocket maximum. This makes having adequate networks covering specialty care more important than ever.

Cost sharing: The lower tier bronze and silver plans require significant cost-sharing for patients. The data reveal high deductibles in the qualified health plans, sometimes nearly as high as the out-of-pocket ceiling. Deductibles for the silver and bronze plans are often at least $2,000 and $4,000, respectively for individuals. Since high deductibles are most often used to discourage the use of health care services, these high deductibles have a significant impact on how patients access care. The maximum out-of-pocket limits set for 2014 are $6,350 for an individual policy and $12,799 for a family policy. Some insurers offer plans in some states with lower out-of-pocket limits. However the out-of-pocket limit does not apply to non-covered drugs or treatment centers.

Transparency: Given the difficulty in navigating the health insurance system and the number of choices for consumers, providing thorough and accurate information is critical to ensuring consumers have the right kind of health insurance.

Further research is being conducted to assess the patient experience, with results anticipated in early spring.

A full version of the report can be viewed here.

About The Leukemia & Lymphoma Society
The Leukemia & Lymphoma Society® (LLS) is the world's largest voluntary health agency dedicated to blood cancer. The LLS mission: Cure leukemia, lymphoma, multiple myeloma, and improve the quality of life of patients and their families. LLS funds lifesaving blood cancer research around the world, provides free information and support services, and is the voice for all blood cancer patients seeking access to quality, affordable, coordinated care.

Founded in 1949 and headquartered in White Plains, NY, LLS has chapters throughout the United States and Canada. To learn more, visit www.LLS.org Patients should contact the Information Resource Center at (800) 955-4572, Monday through Friday, 9 a.m. to 6 p.m. ET.

About Milliman
Milliman is among the world's largest providers of actuarial and related products and services. The firm has consulting practices in healthcare, property & casualty insurance, life insurance and financial services, and employee benefits. Founded in 1947, Milliman is an independent firm with offices in major cities around the globe. For further information, visit www.milliman.com

Contact: Andrea Greif
(914) 821-8958
[email protected]

SOURCE The Leukemia & Lymphoma Society