Sec. 1402. Reduced cost-sharing for individuals enrolling in qualified health plans, of the Patient Protection and Affordable Care Act (H.R.3590) talks about how in the case that of an eligible insured person enrolled in a qualified health plan, the secretary will notify the insurer of the eligibility and then the insurer will reduce the cost sharing under that particular plan. The eligible insured person is defined as a person who enrolls in a qualified health plan in the silver level of coverage in the individual market offered through an Exchange, and whose household income exceeds 100 percent but does not exceed 400 percent of the poverty line for a family of the size involved. The reduction in your out of pocket limit will be based on the level of income and how much it exceeds the federal poverty level. It will be decreased by 2/3 if your income level exceeds the poverty limit between 100-200%, ½ if it exceeds it between 200-300% and 1/3 if the income exceeds the poverty limit between 300-400%. The methods used in reducing the cost sharing will generally be done by the issuer notifying the Secretary of the reduction and then the Secretary will make periodic and timely payments to the issuer equal to the value of the reductions. They will also use a capitated payment system which will take into account the value of the reduction and make any risk adjustments to the payments. Additional benefits to this plan will include a special rule for pediatric dental care in which an individual enrolls in both a qualified health plan and a plan described in section 1311(d)(2)(B)(ii)(I) for any plan year, shall not apply to any portion of cost sharing reduction. There are also special rules for American Indians which include things such as an Indian whose household income is not more than 300 percent of the poverty line for a family of the size involved, then, the individual shall be treated as an eligible insured; and the issuer of the plan shall eliminate any cost-sharing under the plan. If an individual is an eligible insured and its considered to be not “lawfully present” then no cost sharing reduction will be applied with respect to that individual. If a person is considered to be “lawfully present” then an individual shall be treated as lawfully present only if the individual is, and is reasonably expected to be for the entire period of enrollment for which the cost-sharing reduction under this section is being claimed, a citizen or national of the United States or an alien lawfully present in the United States.
I think that this provision of the healthcare bill will hopefully be able to save individuals money by reducing their out of pocket expenditures. In an article I found online from the Center for Budget Policy and Priorities, it talks about increased cost sharing for Medicaid and the adverse affect it has on co-payments. “Current Medicaid policy establishes caps of between 50 cents and $3 per service on copayments for most services, in recognition of the fact that most Medicaid beneficiaries live in poverty. The NGA (national governors association) recommendation would let states increase copayments to, for example, $10, $20, or more for each service — and also allow states to charge sizeable monthly premiums to all Medicaid beneficiaries,” this shows that imposing significant cost sharing on low-income households has been found to have pronounced adverse effects.
Sources:
http://www.opencongress.org/bill/111-h3590/text
http://www.cbpp.org/cms/?fa=view&id=321
