Health insurers have already been grappling with the impact of a rising share of their customers with chronic conditions on their bottom lines.
And insurers have been looking to help patients navigate that health-care transition.
Now, the Federal Trade Commission is trying to force insurers to do the same.
The commission filed a complaint Monday with the FTC’s office in Washington, saying that insurers must comply with its demands that they disclose whether they’re paying out more in premium subsidies to people with chronic health conditions than they are to other patients.
And it said it’s also demanding that insurers set aside money for people with high-cost diseases, including high cholesterol and diabetes.
The complaint said that in the past two years, insurers have shifted from a strategy of paying out lower premium subsidies for people who have high-risk conditions to one of paying more to people who aren’t.
It says insurers need to disclose this information to customers who are enrolled in the Affordable Care Act, or the ACA.
The issue is a hot topic in the health-insurance business, where insurers have struggled to find the right balance between costs and quality.
The industry is also in the midst of a shakeup that could make it harder for insurers to compete in the new health-marketplaces.
Health-insurer executives have long complained about how much premium subsidies they are paying out.
In a report last year, the American Academy of Actuaries estimated that insurers had paid out more than $600 billion to enrollees in the ACA’s marketplaces, but said that many of the subsidies were not always justified.
Some insurers have made a conscious effort to get more people covered through the ACA, and to do so with low-cost plans.
But some also have been cutting out people with serious health problems.
For example, Anthem Inc. is shifting some of its insurance policies to help cover high-level health care expenses, while some insurers have said they won’t pay out any subsidies to those with preexisting conditions.
The American Medical Association and the American College of Cardiology have also criticized the way insurers are billing patients with chronic diseases.
The FTC complaint said insurers have also shifted from offering high-quality health insurance to covering patients with higher-cost conditions.
It said insurers must make the disclosures required by the FTC to patients enrolled in health-in-insurers and the ACA marketplaces.
The agency said insurers could require patients with pre-existing conditions to pay the full premium for the same type of coverage.
Insurers also have to provide the information needed to people enrolled in Obamacare, such as how much their premiums will be, how much they can deduct, and how much is owed in deductibles and co-pays, the complaint said.