Covered California Certified Enroller Practice Exam

Can QHP issuers adjust their cost-sharing compared to other QHPs?

1. Yes, they can vary their cost-sharing

2. No, they cannot vary

3. Only if they are competing for business

4. Yes, but only for pediatric plans

The correct answer is: No, they cannot vary

Qualified Health Plan (QHP) issuers are subject to specific rules regarding cost-sharing structures to ensure consistency and fairness in healthcare coverage. The correct understanding is that they cannot vary their cost-sharing from one QHP to another based on arbitrary criteria or competition. This regulation is in place to provide standardization across the marketplace, ensuring that all consumers have equitable access to health benefits and that they understand the cost implications of their choices. Cost-sharing refers to the out-of-pocket expenses that consumers incur when they receive medical care, such as deductibles, copayments, and coinsurance. By not allowing issuers to vary their cost-sharing effectively, it promotes transparency and aids consumers in making informed decisions when selecting plans. It is crucial for maintaining a level playing field among different plan offerings and ensuring that consumers are not unduly burdened by varying costs for the same essential health benefits across plans. This regulation reinforces the principle that all individuals should have access to affordable healthcare, without the complexities of diverse cost-sharing practices that could confuse or mislead consumers seeking coverage. Thus, the inability of QHP issuers to vary cost-sharing among themselves reflects a commitment to protecting consumers in the healthcare marketplace.