Meg Ivatti (right), a manager at HealthSource RI, the state's insurance exchange, works with Dianiri Paulino to help a caller sign up for coverage in 2014.

Stephan Savoia/AP

Tuesday is the last day of open enrollment for health coverage for 2017 under the Affordable Care Act. And while Republicans in Congress are working to repeal the law, it's not at all clear what might replace it.

During the campaign, President Trump suggested a nationwide insurance market that would allow insurance plans to be sold across state lines.

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The idea has been kicking around for years, and some states have tried it, including Rhode Island, where it didn't work too well.

All Things Considered's Audie Cornish talked to Christopher Koller who was the Rhode Island's insurance commissioner when this option was offered.

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On the roadblocks of allowing out-of-state health insurance options

It's very hard to have interstate insurance. It means that a state has to accept the rules of another regulator. That means if a Rhode Island insurer was licensed in Massachusetts, we have to say that whatever they do in Massachusetts is good for us here in Rhode Island. It also requires significant work to coordinate rules and regulations. Insurance regulators are reluctant to take on this task.

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Let's say Rhode Island didn't allow limited benefit health plans. ... If we were to allow insurance to come in from a state that allowed those plans, and they sold them in Rhode Island, you'd have insurers offering policies that were against the laws and policies set forth by Rhode Island legislature. ... And if insurers are going to sell across state lines, you'll see more variation among states which makes it harder to coordinate and for insurers to operate across state lines.

On how health insurance compares to other lines of insurance

It's not [comparable]. There's a big difference between a hospital and an auto body guy repairing your car. We have a lot more auto body guys than we have hospitals. We don't compel auto body makers to take care of our car if we can't pay for it, but we compel hospitals to treat people if they can't afford to pay for it. We look at health care very differently from auto insurance.

On why out-of-state health insurance can't compete with local

In Rhode Island we have one hospital system that has 80 percent of births in the state. [Insurers] need that in [their] network to be competitive. And I can tell you that if a national insurer walked into that hospital, and said, 'Will you contract with us?' the hospital would have no reason to give the insurer any discount compared to local established health plans have already. That national insurer can't offer a competitive product.

As Republicans look for ways to loosen the Affordable Care Act's coverage requirements, sales of short-term health insurance policies could take off.

Petrol/Westend61/Getty Images

Short-term health plans have been around for decades, bridging coverage gaps for people who are between jobs or have recently graduated from school, among other things.

After the Affordable Care Act was enacted, some people gravitated toward the short-term plans because they were willing to trade comprehensive coverage for a cheaper sticker price — even if it meant paying a tax penalty for not having the comprehensive coverage required in the law. Sales increased sharply.

Now, as Republicans look for ways to loosen the health law's coverage requirements and explore the possibility of not enforcing the requirement that people have health insurance, sales of short-term plans may be poised to grow even more. If that happens, consumer advocates say it could be bad for consumers.

As the policies' name suggests, short-term plans provide coverage for a limited period, often six months or less. They generally don't cover such things as pre-existing conditions, maternity services or prescription drugs. The policies typically have maximum coverage limits of about $1 million. Insurers can turn people down if they're sick and may decide not to renew someone's policy. All of these practices are prohibited in plans that qualify as individual insurance under the Affordable Care Act.

Precisely because of these limitations, however, the premiums are typically a lot cheaper than those for ACA-compliant coverage. In the fourth quarter of 2016, the average monthly premium a shopper would pay for a short-term plan sold through eHealth.com was $124, compared with $393 for someone who bought a regular Obamacare plan and didn't qualify for premium subsidies.

When the health law passed, insurers increasingly began offering short-term plans that stretched the definition of "short," sometimes providing coverage for as long as 364 days.

"Carriers were exploiting a loophole in the law that defined a health insurance plan as one that was 365 days," said Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms. "If they were shorter they didn't have to comply with ACA protections."

Short-term plans serve a tiny but growing proportion of the roughly 22 million people who have coverage on the individual market. At the end of 2013, before the health law's major reforms took effect, there were approximately 108,800 people covered by these policies, which earned premiums of $97.5 million, according to figures from the National Association of Insurance Commissioners. Two years later, roughly 148,100 people had short-term plans and premium earnings had grown to $160.5 million.

Some insurers have taken notice. Online health insurance vendor Health Insurance Innovations launched Agile Health Insurance in the spring of 2015 to focus on sales of short-term plans. In the third quarter 2016, Agile sold 21,000 short-term policies.

"These short-term plans are not regulated like Obamacare plans, so carriers have a lot of flexibility in benefits and pricing," said Sam Gibbs, Agile's executive director. "It's almost like the old individual market before the ACA."

Not all insurers embrace widespread sale of short-term plans. "The big health insurance companies are really mixed on this," said Timothy Jost, professor emeritus at Washington and Lee University School of Law and a close watcher of the health law. "They see this as a seriously destabilizing force in the market, this crap coverage."

Last October, the Obama administration issued a final rule that would make it more difficult for consumers to buy short-term plans to substitute for regular Obamacare plans. The regulation, which takes effect April 1, said short-term plans must be less than three months in duration. People can request a renewal of the policies, but insurers can turn them down. The policies and related materials also have to prominently display a warning that they don't satisfy the law's requirement that people have health insurance.

Some hope that the rule may be changed or rescinded by the Trump administration or overturned by the new Congress under the little-used Congressional Review Act. Neither option can happen at the stroke of a pen, however.

Health insurance brokers and agents would like to continue to sell longer-term short-term plans.

"Our folks do a lot of business with short-term plans," said Marcy Buckner, vice president of government affairs at the National Association of Health Underwriters, an industry group. The regulation is one that the group will request that the Trump administration rescind.

"In most areas [a short-term plan] is cheaper, and it's some consumers' way of saying, 'I don't need all of those things,' " said Buckner.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Follow Michelle Andrews on Twitter: @mandrews110

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PRIVATE health insurance members with extras cover should be doing a simple maths equation to work out if having it is worth the cost.

About half the population has private health hospital cover, which for many has enticing tax benefits, but finance experts say it remains questionable whether extras cover makes sense.

The latest Australian Prudential and Regulation Authority statistics found in the September quarter 13.4 million Australians have some form of “general treatment” or extras cover which includes dental, optical and physiotherapy.

But with significant hikes to insurance premiums every year on April 1, consumer group Choice’s spokesman Tom Godfrey said it pays to sit down and work out whether you’re paying too much for the financial benefit you receive.

“With health insurance premiums increasing on average 48 per cent since 2009 you need to look at how you can save money on your insurance,’’ he said.

“This is a good time to assess your extras cover, if you can drop extras you can save up to about 45 per cent on your annual premium.”

Melissa Ladner, 35, has singles extras cover and uses it to claim for optical and physio.

“I claim the maximum on physio which is a few hundred dollars cover a year and the optical I have claimed the maximum amount both years,’’ she said.

“I’ve never done the maths to see if it’s worth it but I plan on keeping extras cover.”

Mr Godfrey said the way to check whether you are getting any financial gain is to contact your insurer and ask for an annual claims statement.

Then scroll through what claims you have made over this period.

Ask how much you are paying for your extras premium and how much money you got back to see if there’s any benefit.

“If you are paying out more in premiums than you are getting back in benefits consider dropping your extras cover and put money aside instead for your annual trip to the dentist or the physio,’’ Mr Godfrey said.

Medibank’s chief customer officer David Koczkar said a majority of the insurer’s customers do take out extras cover.

“They do see real value in that product line, it’s both about value and staying healthy,’’ he said.

“We are investing in making sure our members use their extras, whether it be reminding them that they haven’t had their free preventive dental check-up.

“Look at waiting periods and make sure you understand what types of services require waiting periods and make sure you are getting the best product for you.”

Medibank said the cost of extras does vary but as an example it can start from $5.60 per week for a single person.

Originally published as Self-check your health insurance extras