Urgent Care Pushes CMS to Adopt Patient Copays Instead of Coinsurance

The Urgent Care Association (UCA) sent a letter to the Centers for Medicare and Medicaid Services (CMS) in favor of lowering the copay patients would be responsible for when visiting an urgent care visit, effective in 2018. The changes would affect the cost-sharing structure for “standardized options” (ie, Simple Choice plans) that plan issuers offer in the individual insurance marketplace. Standardized options are intended to simplify the consumer plan selection process; each has a single provider tier and a fixed deductible, annual limitation on cost sharing, and copayment for a key set of essential health benefits that make up a substantial portion of the total allowable costs for a “typical population” of plan members. UCA wrote that it supports a set copayment for urgent care visits under the bronze plan, rather than the 50% coinsurance that patients will have to pay throughout 2017. Coinsurance can create confusion for patients and add work for front desk staff, as charges have to be estimated at the time of the visit. The copay proposed for bronze plan members would be $75.