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Various health plans sold through the health insurance marketplace may actually overlapped with Medicaid coverage. The Association for Community Affiliated Plans (ACAP) released a study that shows about 40 percent of issuers providing Qualified Health Plans via the health insurance marketplace also offer Medicaid managed care coverage in the same state, according to a company press release

The study found that 137 out of 335 issuers had health plans that overlapped with Medicaid managed care coverage. While this may be true, the study also discovered that many individuals despite living in states with overlapping coverage would still be unable to access health plans that are available both through the health insurance marketplace and the Medicaid program. 

These type of overlapping issuers could make coverage simpler for low-income families and individuals whose eligibility may change from Medicaid coverage to tax subsidies offered via the health insurance marketplace. Small deviations in income even on a short-term basis could bring some families from obtaining tax subsidies for insurance offered through the exchanges to Medicaid coverage.

The report outlines that seasonal employment or a change in the number of working hours could all affect income level and the type of coverage a person may be eligible for. When health plans don’t overlap between Medicaid coverage and standard subsidized insurance through the marketplace, consumers may suffer from a gap in coverage.

This could lead to unfilled drug prescriptions, deteriorating health, and obstacles in access to medical care among those who lack health coverage for a period of time. Even those who are able to quickly enroll in a new health insurance plan and avoid any gaps in coverage, these individuals may still need to find a new primary care physician because the new plan is likely to be out-of-network for their current provider.

“We’ve come a long way in expanding affordable coverage options across the spectrum of incomes, but a few rough edges are still there,” ACAP CEO Margaret A. Murray said in a public statement. “Switching plans under any circumstances can disrupt treatment regimens or doctor-patient relationships. Highlighting these overlap issuers points up an option for consumers that might help to smooth the transition.”

Overlapping issuers could help prevent some of these problems since these health plans are often similar or identical in nature. Additionally, it could help some families who have split eligibility with parents eligible for subsidized insurance through the health insurance marketplace and children eligible for CHIP or Medicaid.

At this point in time, 36 states have at least one overlapping issuer, according to the report. One problem though has been the fact that a high number of counties in various states do not provide the option for consumers to be able to choose plans between their subsidy or Medicaid eligibilities.

For example, in Texas, almost 70 percent of counties do not offer these overlapping insurance options. Only 12 percent of Texas counties have more than one overlap issuer available, the report found.

“In New York and Texas, consumers in big cities tend to have more choice,” Murray explained. “That’s not particularly surprising, but the degree to which the difference exists in Texas is striking. This particular finding shows that just like in politics, all health care is local.”

The report from ACAP also discovered that the number of overlap issuers has risen by 7 percent in the last year. This type of overlap in coverage is especially beneficial for low-income families.

“While more study is needed to determine precisely how overlap between Marketplace QHP issuers and Medicaid MCOs will benefit enrollees, participation by issuers in both the Marketplaces and Medicaid has the potential to strengthen continuity of coverage and care for low-income healthcare consumers,” the report stated.

“Marketplaces in 33 states include a QHP issuer that also offers a Medicaid MCO, so consumers in those states potentially can stay with their plan if they experience a change in eligibility between Medicaid or CHIP and the Marketplace. Of the 338 QHP issuers nationally, 131 (39%) also operate MCOs in the same state where they participate in the Marketplace.”

While there are still challenges that need to be overcome when it comes to ensuring all Americans have health insurance and access to care, the Affordable Care Act and the health insurance marketplace has greatly broadened coverage options for the average American family.

The health insurance exchanges created through the Affordable Care Act enable small and medium-sized employers as well as consumers obtain access to care through qualified health plans.

As the health insurance landscape evolves due to innovative solutions from public and private payers, there may be more options for low-income families to ensure they never suffer from a gap in medical care. The goals of the Affordable Care Act have been to reduce healthcare spending, improve access to care, and strengthen the quality of medical services.

Posted 10:34 AM

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