Increased Transparency and Consumer Protections for 2016 Marketplace Plans

The open enrollment period that ends in December 2015 for coverage begin­ning January 2016 marks the third year of the health care exchanges or marketplaces and of coverage through new qualified health plans. This issue brief investigates several key changes to the qualified health plans, with a focus on increased transparency and consumer protections. A new out-of-pocket costs calculator, requirements regarding provider networks, and prescription drug cost-sharing requirements should serve to better inform and improve consumer selection. In addition, several policy changes will help individuals with more severe health needs. These include: improved prescription drug coverage for HIV/ AIDS and other conditions, allowing prescription drugs that are obtained through the "exceptions" process to count toward the out-of-pocket spending cap, more comprehensive and consistent habilitative coverage, and an individual out-of-pocket spending cap within the family out-of-pocket maximum.