Wisconsin short-term health plan denies further applications

Most of Wisconsin’s short-term health insurance plans don’t cover mental health or substance abuse treatment, nor do they cover maternity care, according to a report released Thursday by the Office of the State Insurance Commissioner, but all are prescription drugs. and pay for cancer treatment.

Short-term plans, which are typically cheaper than regular insurance because they don’t have to meet many requirements of the Affordable Care Act, denied 31.3% of claims in 2021, compared with 31.3% of claims in Wisconsin in the federal market. The state plan rejection rate was 11.7%. said the report.

In 2021, only 10,310 residents had a short-term plan, while more than 200,000 had insurance through the private market, sometimes called “Obamacare.” With Republican lawmakers looking to expand insurance plan coverage, Democratic Gov. Tony Evers wanting to limit it, and with 2024 insurance coverage coming soon, the report is the first in-depth look at insurance plans. provide.

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The plan, which aims to provide people with short-term insurance between more stable coverage, can last up to one year and can be extended for an additional six months in Wisconsin. Of the plans offered in the state by more than a dozen insurers in 2021, the average monthly premium was $157 with terms ranging from one month to one year. Those aged 55 to 65 were most likely to enroll.

The plan is not required to cover pre-existing illnesses or “essential benefits” such as maternity care, mental health and prescription drugs. Critics say many consumers aren’t aware of this when they sign up, which can lead to unexpected charges.

“Thousands of people in Wisconsin are on[short-term plans]and we want to make sure that these consumers are informed about the scope and limitations of these plans,” said the state insurance commissioner. Nathan Hoedek said in a statement announcing the report.

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The report was funded by the Federal Center for Medicare and Medicaid Services and edited by the Beredan Health Analytics Practice Group, led by longtime Madison-based health policy analyst Donna Friedsum.

A bill introduced by state Republican lawmakers in 2021 would have allowed short-term plans in Wisconsin to last up to three years instead of 18 months. The bill did not pass the Republican-controlled Congress, and no similar bill appears to have been introduced in the current Congress.

In the past two budget proposals, including this year, Evers has tried to limit the total duration of the plans to six months.

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