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December 09, 2014 at 12:18 PM
The Patient Protection and Affordable Care Act (PPACA) public exchange system has been up and moving for about a year.
The PPACA Summary of Benefits and Coverage (SBC) provision and other notice provisions have been here longer than that, and we’re now more than three weeks into the second annual exchange plan enrollment period.
Some benefits industry veterans have looked at PPACA World in the past few weeks and sent use reports about they’ve seen.
To learn more about their observations, read on.
1. Nothing has gotten any simpler
One goal of the PPACA drafters was to cut health care system costs by easing administrative complexity.
Representatives from the UnitedHealthcare unit of UnitedHealth Group (NYSE:UNH) tried to give us a simple description of what’s been happening in one small corner of PPACA World — the dental and vision insurance market — and ended up taking several hundred words just to describe the new distribution channels that are now available.
PPACA requires basic pediatric vision and dental benefits to be part of the essential health benefits (EHB) package that major medical plans are supposed to try to cover.
In practice, UnitedHealthcare reps said, all of the health plans sold through the new PPACA exchanges do include coverage for an annual routine pediatric eye exam and basic annual pediatric eyewear purchases.
The picture for pediatric dental benefits is less clear.
The UnitedHealthcare reps said their company sells coverage through traditional channels; through the public exchange system; through independent private exchanges; through its own private exchange system; and through an exchange-like multi-plan choice product it developed in 2008.
A few weeks ago, officials at the Centers for Medicare & Medicaid Services (CMS) made headlines when they reported that they had accidentally added dental enrollment to major medical enrollment when they had said the exchanges ended August with about 7.3 million enrollees.
Republican critics of the PPACA exchange plans accused CMS officials of intentionally using the dental enrollment figures to inflate the major medical enrollment total, to get over the 7 million-enrollee goal included in Congressional Budget Office (CBO) office projections.
Some of the 6.3 million exchange plan enrollees may have gotten dental coverage from another source, but supporters of the goal of getting access to basic dental coverage noted that the CMS figures may mean that fewer than 10 percent of exchange plan enrollees have ready access to basic dental coverage.
