Comment on CMS-2026-2081-0001

RE: CMS-9874-NC Employer plans are far more widely received with stronger numbers of doctors and hospitals welcoming employer plans which is not the same in ACA plans which are not favored contracts. The contracting or reimbursement arrangements being offered to physicians by ACA plans, I suspect, is substantially lower payment and unattractive contracts. Networks for the ACA plans need significant improvement. Many people do not want an HMO and many request a plan that can be used outside of a local county area. Plans should continue to include preventive care. Most plans should have to set a specific copay for a majority of services so that costs are more predictable when accessing care. People can see that with large deductibles that the plan is not helping with their care and setting numbers that are obviously designed to profit the insurance company and leave the patient holding the majority of anticipated medical costs. Catastrophic plans under ACA are not making access to care affordable at all by not covering any physician office visit or prescription until over $10k has been spent per individual. Employers do not offer catastrophic plans that are this limiting. Employers continue to offer plans regularly that are a maximum out of pocket of $3k to $5k while the ACA has gone up and beyond $10k. Some clients have found COBRA offered a better deal than full price ACA plans where no subsidy was available with better access to doctors and better out of pocket. The current limit of $85k or over for a couple to get zero subsidy is too low and many couples in their 60's decided to drop insurance this year as they wait out the last year or two before getting to Medicare. They could not justify $2000 a month in premiums with $10,000 in max out of pocket for each spouse. They made the decision they were better off to self insure than to spend $24k for a bad plan design.