Information Regarding Changes to adultBasic Insurance Plan

Increased monthly premium payment

This subsidized premium will increase from $35 to $36 per month.  Approximately 40,000 individuals receive subsidized coverage. The actual premium cost to buy coverage while on the waiting list will increase from $330 to $600 per month.  Currently 3,500 of the 383,000 on the waiting list purchase coverage at cost.

Increased co-payments or coinsurance for certain health services

Increased payments will include:

Primary care physician office visits (current $5; after March 1 $10)
Specialist doctor office visits (current $10; after March 1 $20)
Emergency room co-pay (current $25; after March 1 $50)

There is a 10 percent coinsurance/$1,000 maximum per year for services that prior to 3/1/10 have no charge:               

Diabetic supplies
Outpatient surgery
Cardiac rehabilitation
Chemotherapy, dialysis, or radiation
Pulmonary rehabilitation
Respiratory therapy
Home infusion
Home health care
Skilled nursing facility care
Inpatient rehabilitation therapy

Limited inpatient hospital services benefit and physical occupational and speech therapy services 

Inpatient hospital services will be limited to two stays per year. The combined PT, OT, and Speech services are limited to 15 visits annually. Both items include the 10 percent coinsurance/$1,000 maximum per year for all coinsurance for services that prior to 3/1/10 have no charge. 

As the Governor noted in his budget address the Community Health Reinvestment Agreement (CHRA) negotiated in 2005 between the administration and the Blues Plans expires December 31, 2010.  The CHRA currently provides approximately 60 percent of the funding for adultBasic while the remaining funds are provided through the Tobacco Settlement Agreement. 

Insurance Commissioner Joel Ario Statement
Senator Don White Response
Additional Insurance Plan Information