Could individuals use “skinny” plans that fail to meet the new “minimum essential coverage” standards to get out of paying the new penalty on the un- and underinsured?
Gary Cohen, head of the Center for Consumer Information & Insurance Oversight (CCIIO), has left that possibility open in a new bulletin on insurance standards.
CCIIO is the arm of the Centers for Medicare & Medicaid Services (CMS) directly in charge of implementing many Patient Protection and Affordable Care Act (PPACA) provisions, including the PPACA public exchange program. PPACA health insurance requirements, and the PPACA “shared responsibility” penalty programs.
CMS, in turn, is an arm of the U.S. Department of Health and Human Services (HHS).
HHS would like to see the minimum essential coverage plan meet “substantially all” of the standards that ordinary, non-grandfathered individual major medical policies are supposed to meet starting in 2014.
A proposed plan should offer the PPACA essential health benefits package and meet PPACA appeals standards, Cohen says.
But “HHS also foresees that there may be situations where recognition of a plan as minimum essential coverage is reasonable and appropriate even where the plan does not meet the ‘substantially all’ standard,” Cohen says. “Accordingly, plans that do not meet all of the foregoing requirements will be evaluated on a case-by-case basis.”