AAFP chair makes suggestions for health insurance marketplace improvements
Although Wergin said the programs are helpful and appreciated by the AAFP, there are some missing elements from the health insurance marketplace that could make them even better.
In his letter, Wergin suggested mandates that would require health insurance companies to compare their costs and coverages for primary care and sub-specialty physicians and to provide patients with up-to-date listings of health professionals and facilities in a plan's network.
“The AAFP appreciates CMS recognizing and encouraging the value of primary care for patients who would enjoy ‘first dollar coverage’ for that care,” Wergin wrote. “We believe this insurance design feature to be extremely important for patients with long-neglected ailments, who are gaining health insurance for the first time. Covering primary care visits, generic drugs and other services as a covered benefit before the deductible is applied would provide an appropriate incentive to enrollees to use the preventive care and chronic disease management -- as well as early diagnosis and treatment of acute conditions offered by family physicians and other primary care providers.”
Wergin urged CMS officials to tighten standards on provider networks and make performance measures and patient feedback on plans public. He stressed the continued need for access to care for all patients.
“The AAFP applauds CMS’ decision to exempt from the deductible primary care and generic drugs in the 2017 Standardized Plan Options and urges CMS to make that part of an essential health benefit in the future,” he wrote. “Primary care should be covered without a deductible at all three metal levels to encourage consumers to rely on the preventive health care and chronic disease management offered by primary care physicians. Exempting primary care services from the deductible would encourage consumers to visit their primary care physician for conditions they might feel they could ignore.”
Organizations in this story
American Academy of Family Physicians 11400 Tomahawk Creek Pkwy Leawood, KS - 66211