Washington, DC—A recent 50 state study by Georgetown University Center on Health Insurance Reforms and the Urban Institute shows that DC is among 7 states that minimized cost as a barrier to medical care through required standardized plan designs.
The study, funded by the Robert Wood Johnson Foundation, found that six states and the District of Columbia were able to lower cost-sharing for specific health services and drugs through standardized benefit plans sold through the Affordable Care Act’s state-based health insurance marketplaces. The plans cover pre-deductible services with zero to moderate co-payment amounts for doctor’s visits for non-preventative primary care and specialty care, mental health and substance abuse, urgent care, and generic prescription drugs.
“From day one, DC Health Link has offered robust coverage choices,” said Dr. Leighton Ku, Chair of the DCHBX Standard Plans Advisory Working Group. “Policies such as standardized benefit design help simplify consumer decision-making and create a more transparent and competitive shopping experience for District residents, while improving access to medical care.”
DC Health Link, the District’s online health insurance marketplace, offers standardized plans so that consumers can make “apples-to-apples” health insurance plan comparisons knowing that every standard plan within the same metal tier has the same cost-sharing amounts and benefits. These plan designs focus on ensuring that people can access certain medical services without deductibles and with low out of pocket costs.
Standardized plans have been available through DC Health Link’s individual marketplace for several years. In 2013, the DC Health Benefit Exchange Authority Executive Board (DCHBX) adopted a resolution to require plans with standardized benefit design to be offered by health insurance companies in addition to the non-standardized benefit designs.
In 2013, the DCHBX Board also adopted the consensus recommendations of the Plan Offerings and Benefit Standardization Working Group Chaired by Kate Sullivan Hare, Member of the DCHBX Executive Board, and Vice Chaired by Claire McAndrew from Families USA. The standardized plan designs were developed in 2014 and 2015 and first offered through DC Health Link in 2016. Each year, plan designs are updated by the DCHBX Standard Plans Advisory Working Group chaired by Leighton Ku, DCHBX Executive Board member, and Vice Chaired by Dania Palanker from Georgetown University. The working group’s diverse membership includes health plans, brokers, consumer advocates, and DC Health Link customers. The Working Group’s meeting materials and plan designs can be found here.
The DC Health Benefit Exchange Authority DCHBX) is a public-private partnership established to create and operate DC’s state-based online health insurance marketplace, DC Health Link.