Direct Primary Care Arrangements Raise Questions for State Insurance Regulators
Over the past year, new health coverage products not subject to the Affordable Care Act’s consumer protections have hit the individual market. In a new To the Point post, Maanasa Kona, Kevin Lucia, and Sabrina Corlette of the Georgetown University’s Center on Health Insurance Reforms look at what are known as direct primary care arrangements. Under these contracts, a primary care provider agrees to deliver services to a patient for a monthly fee.
Kona and colleagues explain that critical consumer protections -- such as guaranteed coverage regardless of health status or gender and coverage of the essential health benefits established by the ACA – may not apply to these arrangements. The authors, who examine regulatory approaches by state, say that state insurance regulators need to take steps to protect consumers and prevent financial insolvencies.
“With the rise in popularity of direct primary care arrangements, especially among the uninsured, states might have to consider, or reconsider, their regulatory stance.”
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