The plan: five benefits, two designs
The proposed law would set one national core benefit for qualified U.S. citizens. Other eligible residents could buy in under rules set by Congress and CMS.
What would be covered
Medical
Preventive, diagnostic, hospital, physician, emergency, mental-health, surgical and rehabilitative care.
Dental
Dental care as part of the core benefit, not a separate policy most families go without.
Vision
Eye care included in the same coverage, with the same card.
Hearing
Hearing care, including the services people now postpone because of cost.
Prescriptions
Outpatient prescription drugs, backed by national purchasing leverage.
Medical coverage would include medically necessary preventive, diagnostic, hospital, physician, emergency, mental-health, surgical and rehabilitative care. Each of the five categories would be priced separately, so the $9,984-per-person annual ceiling can be tested rather than assumed.
Two ways to share costs
The proposal offers two designs for the same five benefits.
Beyond the core benefit
Extended care: up to 120 days a year
HEALTH5 would include medically necessary skilled nursing, rehabilitation, qualified home health care and habilitation for up to 120 covered days per person per benefit year. That is separate from indefinite custodial long-term care, which could be covered through supplemental insurance, long-term-care coverage, Medicaid eligibility or personal resources.
Supplemental coverage you could add
Private insurers could keep selling coverage that sits on top of HEALTH5:
- Indemnity coverage for the $5,000 exposure under UHC-5000
- Extended skilled nursing, rehabilitation and home care
- Long-term custodial care
- Enhanced dental, vision and hearing benefits
- International coverage, and life insurance with living benefits
Supplemental insurance would add to HEALTH5, not replace it.
Five years of steady coverage
Once you enrolled, you would generally stay with your assigned insurer for five years. The insurer could not end your coverage because your health got worse or your claims got expensive.
Defined exceptions would cover insurer insolvency, moving, changes in eligibility, CMS enforcement actions and major family changes.
Families would be priced fairly
$832 is a per-person average, not a flat family price. CMS would set age and dependent factors, because children generally cost less to cover than older adults. A family’s cost would be built from the expected cost of each member.
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