Colo. Insurance Division: First Annual Report on Health Care Sharing Plans and Arrangements From Colorado Division of Insurance
For a number of years, the DOI has received many complaints and questions about HCSAs in
"The types of complaints we hear from consumers, typically centered around an HCSA not paying for a health care service, leaving the person stuck with a bill for thousands of dollars, are not just heartbreaking, but frustrating," said Colorado Insurance Commissioner
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HCSAs do not offer the same protections and benefits as Affordable Care Act (ACA) plans. Many of the HCSAs reported excluding benefits such as contraception coverage, mental health services, alcohol use disorder treatments, ADHD treatments, prescription drugs for chronic conditions, comprehensive reproductive health coverage (in most cases including coverage for abortion), and some pre-existing conditions. Many also reported excluding or placing limitations on maternity care unless the pregnant person had been a member of the HCSA's highest membership tier for some previous amount of time .
Additionally, there are no guarantees that HCSA members will have their healthcare costs paid for through the "sharing" provisions in the groups. Some HCSAs specifically state that members are personally liable for payment of their medical bills.
Some require that members first request health care providers and hospitals to reduce or write off health care bills. Other HCSAs actually require members, after members have paid HCSAs for coverage, to first request charity care and financial support from local governments and consumer support organizations in paying the member's health care bills. For members who also have Medicare, HCSAs often require that members only use the HCSA after health care costs are submitted to Medicare.
Yet from the consumer complaints the DOI receives, it appears that consumers do not fully understand these limiting provisions, and that consumers often don't understand what they are signing up for when they sign up for a HCSA. Typically, most of the consumers contacting the DOI believe they have something that works like a full ACA health insurance plan, with benefits to cover their health needs, and all of the protections that are part of such plans.
Coloradans who experience problems with their HCSA should contact the
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Report link: https://drive.google.com/drive/folders/1xPJMWwDtjSKl1P91TROoRmOWfCIb6wCo
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Original text here: https://doi.colorado.gov/news-releases-consumer-advisories/first-annual-report-on-health-care-sharing-plans-and-arrangements
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