New ACA rules may add employer "Priceline" health plan options

The plans would let patients use any doctors who are willing to accept the reimbursement rate offered by the plans.

The non-network plans, which are also called "reference-based pricing" plans, would have to show that they offered prices high enough that enough doctors were willing to take those prices, and the plans would have to show that they had alternative arrangements available when no providers were willing to take the reference price.

Related: Some 2027 ACA exchange plans could ditch provider networks

The plans could be available starting in 2028.

State regulators could choose whether or not to let insurers sell the non-network plans to their residents.

A second provision in the final 2027 parameters notice would let insurers sell catastrophic health insurance plans to any exchange plan buyers who do not qualify for ACA premium tax credit subsidies.

An ACA catastrophic plan covers only about 50% of the value of the ACA "essential health benefits" package, or standard benefits package, and few benefits at all, other than coverage for basic preventive services and three routine office care visits per year, until the enrollee reaches the deductible, which is $10,600 this year for an individual.

Current rules make catastrophic plans available only to consumers under 30 and exchange plan buyers who earn too much to qualify for exchange plan tax credits and can show that they face a hardship.

The new parameters notice eliminates the need for higher-income catastrophic plan buyers to show that they face a hardship and could help turn catastrophic coverage into a mainstream product.

The catastrophic plans could stay in place for up to 10 years.

The new catastrophic plan eligibility rules will be effective 60 days after the official notice publication date.

The new catastrophic plan rules will apply directly only to coverage sold through the ACA exchange system.

Employer plans and catastrophic plans: CMS officials suggested in the "preamble," or official introduction, to the final notice that workers who have individual coverage health reimbursement arrangement plans, or ICHRA plans, could use cash from their employers to buy catastrophic plans and put cash in health savings accounts to cope with the high catastrophic plan deductibles.

Employers and non-network plans: CMS officials do not talk about workers using non-network plans, but some employers have already experimented with offering plans that use a reference-based pricing strategy for some or all services.

Companies like Sidecar and Imagine360 have offered individual consumers products that combine reference-based pricing with mobile phone apps that help patients find doctors willing to accept the price.

Commenters at the American Hospital Association have argued that reference-based pricing is bad for patients and simply pushes more of the cost of care away from insurers and health plans and onto the shoulders of patients and providers.

The American Medical Association has suggested that reference-based pricing might be appropriate in some situations, if patients understand the costs and hospitals or facilities avoid using reference-based pricing to shift costs from one set of services to another.

If large numbers of patients with individual coverage were using well-designed reference-based pricing coverage that physicians liked, that could increase their interest in working with employer-sponsored plans that use reference-based pricing strategies.

If patients came in with coverage from non-network plans that worked poorly, that could decrease physicians' willingness to take patients with employer-sponsored non-network plans.