UCAOA Asks CMS to Align Primary Care and Urgent Care Visit Copays
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On Oct. 6, 2016, UCAOA sent a letter to the Centers for Medicare and Medicaid Services (CMS) in support of proposed changes to the cost-sharing structure for urgent care for standardized options, or Simple Choice plans, that plan issuers offer in the individual insurance Marketplace. If finalized, the new cost-sharing structure would be effective in 2018.

The standardized options, designed to simplify the consumer plan selection process, each have a single provider tier, fixed deductible, fixed annual limitation on cost sharing, and fixed copayment or coinsurance for a key set of essential health benefits that comprise a large percentage of the total allowed costs for a typical population of enrollees. These fixed cost-sharing values are for in-network care only.

In its comment letter, UCAOA specifically expressed support for a set copayment for urgent care under the bronze plan level rather than the 50 percent coinsurance finalized for 2017. An urgent care copayment of $75 is being proposed for the bronze plan, but UCAOA commented that the copayment should be more closely aligned with the copayment for a primary care visit which is proposed at $35 under the bronze plan. UCAOA stated the urgent care copayment should be lower since consumers often have difficulty accessing primary care physicians for urgent acute care needs.

Under the proposed standardized options, urgent care visits would not be subject to the plan’s deductible, a position also strongly supported by UCAOA.

The Notice of Benefit and Payment Parameters for 2018 Final Rule is expected to be published in early 2017.
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