Massachusetts health insurance connector board votes to require prescription drug coverage as part of draft minimum coverage requirements

Mar 22 2007

The Massachusetts Commonwealth Health Insurance Connector Authority on Tuesday approved minimum coverage requirements for health insurance plans to comply with the state's universal coverage law, including requiring prescription drug coverage, the New York Times reports.

The requirements, which are subject to final approval in June, would make Massachusetts the first state in the U.S. to establish standards for its residents and insurers. Under the state's health insurance law, all residents must obtain health care coverage or face tax penalties. The board on Tuesday agreed to phase in some of its requirements to allow residents and employers an additional 18 months to buy health plans that meet the new criteria. Residents will need to have some level of coverage by July 1 but will not have to meet the required level of coverage until January 2009 (Belluck, New York Times, 3/21). The board also agreed to place a maximum deductible of $2,000 on individual plans and a $5,000 annual limit on out-of-pocket spending if beneficiaries use health care providers within an insurer's network. The minimum standards would require all plans to include prescription drug coverage and allow plans to charge beneficiaries an additional deductible for drugs of up to $250 for individuals. The board in June will consider a less-expensive requirement for drug coverage that might include higher deductibles but that would require coverage of drugs for chronic conditions before the deductible applies. The board hopes the higher-deductible drug plan will add no more than 5% to the premiums of health plans. In addition, board members agreed to allow insurance plans to continue placing caps on lifetime coverage.

Exemptions
Jon Kingsdale, the connector's executive director, said the board would consider exempting penalties for individuals whose employers do not offer coverage that meets the new requirements. The board already has agreed to continue accepting certain plans that do not meet the new standards, even after the January 2009 deadline. Those plans include policies for young adults ages 19 to 25 whose employers do not provide insurance; federally sanctioned high-deductible plans with health savings accounts; Medicare; and plans provided by religious groups. The board next month will consider standards for providing waivers to individuals who cannot afford low-cost plans (Dembner, Boston Globe, 3/21).

Comments
Stuart Altman, a professor of health economics at Brandeis University, said, the new requirements are "setting the definition of what is acceptable health care coverage, which is really unique in America" (New York Times, 3/21). Kingsdale said, "All the (minimum) requirements are significant steps in setting precedents for what other states are going to be looking at." Jon Hurst, president of the Retailers Association of Massachusetts and William Vernon of the National Federation of Independent Business, in a statement said, "We remain concerned that the proposed standard will in the future eliminate affordable products currently available in today's marketplace" (Boston Globe, 3/21).