President Joe Biden's proposed $3.5 trillion Build Back Better framework has the potential to significantly shake up the health insurance landscape, according to a Kaiser Family Foundation analysis.
Here are seven potential results of the act, according to the foundation:
1. Several sections of the Build Back Better framework would extend and expand American Rescue Plan Act subsidy eligibility through 2025. It would also allow those receiving Social Security to disregard lump sum benefit payments in determining eligibility.
2. The act would cover hearing services in 2023 under Medicare Part B. While 97 percent of Medicare Advantage plans offer hearing coverage, this would extend coverage for 36 million beneficiaries who would not have it covered otherwise.
3. Notably, the act would allow the federal government to negotiate "a small number of high-cost drugs lacking generic or biosimilar competitors covered under Medicare Part B and Part D," according to the Kaiser Family Foundation. The number of negotiated drugs would increase from 10 in 2025 to 20 in 2028 and beyond.
4. In a move affecting both the government and private insurers, the act would cap cost sharing on insulin to $35. The act would also require vaccines recommended by the Advisory Committee on Immunization Practices to be covered at no cost.
5. Beginning in 2014, the act would put a hard cap on Medicare Part D out-of-pocket spending, set initially at $2,000 and slightly increasing annually. Beneficiaries would also only pay 23 percent of costs below the cap.
6. The act would take steps to address individuals in 12 states who are in the coverage gap between Medicaid and Medicare eligibility, allowing them to purchase ACA marketplace plans through 2025.
7. Postpartum coverage under Medicaid would be extended from 60 days to 12 months. It would also allow states to use maternal health home models to coordinate care.