Jason Young competes in the Men's Discus Throw qualification on Day 10 of the London 2012 Olympic Games. (Michael Steele/Getty Images)

Olympic athletes’ health plan fails to meet Affordable Care Act rules

It might seem like common sense that top U.S. Olympic athletes would have excellent health insurance to cover potentially serious injuries and illnesses.

But it turns out that the health plan for about 900 elite athletes — provided through the U.S. Olympic Committee — fails to meet minimum requirements of the Affordable Care Act. Under the law’s individual mandate, almost all Americans are required to have insurance or face a penalty, which is due when their income taxes are paid.

When it became apparent in recent months that athletes could face penalties for the 2014 tax year for having inadequate coverage — through no fault of their own — federal health officials decided to grant exemptions to all affected athletes who apply, according to federal health officials.

Chris Barnes bowls during Day 11 of the XVI Pan American Games at the Tapatio Bowling Alley in Guadalajara, Mexico. (Mike Ehrmann/Getty Images)

Athletes were informed about the potential problem by the USOC, and many of them have filed and received an exemption.

Jason Young, 33, a discus thrower who was on the 2012 Olympic team and insured through the program for part of last year, has already received his exemption, he said.

For the 2014 tax year, the penalty is 1 percent of yearly household income or $95 per adult, whichever is greater.

“We are providing a limited exemption to enrollees for the months they were covered by this plan in 2014,” said Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services (CMS), in a statement Friday, referring to the athletes. He noted that the athletes were not to blame and that the USOC is working to meet the federal law’s requirements for 2015.

Under the law, health plans in the individual and group markets must meet certain minimum requirements, including limits on out-of-pocket costs. The plans are required to provide a specific set of benefits, including prescription drug coverage and preventive services, and are barred from having lifetime and annual caps on benefits.

But the USOC plan has a $25,000 deductible for sports injuries and a $7,500 lifetime cap on hospice care. Its out-of-pocket maximum does not include prescription drugs and outpatient professional physical medicine, according to a copy of the program benefits provided by the USOC. (A sport’s national governing body pays the first $25,000 for sports injuries; the insurance policy is a taxable benefit.)

Athletes see doctors and trainers at a greater rate than the average consumer because even a minor health problem can affect performance, sports medicine experts have said.

The health plan, known as the Elite Athlete Health Insurance Program, is a medical insurance plan offered only to TeamUSA’s top athletes and their dependents. Athletes have to qualify annually for the coverage based on their performance. The plan is similar to coverage offered through employers. Policies are divided among the national governing bodies for individual sports. About 900 athletes and 200 dependents are currently enrolled.

A spokesman for the USOC said the organization learned early this year that it needed to make changes to the health plan.

According to a person involved in the federal exemption process, some athletes initially had their applications denied. That prompted USOC executives to complain to administration officials, and about a month ago, CMS officials directed that “high priority” be given to the athletes, said the person, who spoke on the condition of anonymity because he wasn’t authorized to talk publicly about the program.

USOC spokesman Mark Jones said in a statement that although the insurance program provides “generous benefits at extremely affordable rates for athletes, certain technical changes needed to be made in order for the plan design to be compliant with the Affordable Care Act.” He did not provide specifics.

“We continue to work with our partners in the government to ensure that is the case moving forward, while working with athletes to ensure they have substantial input to the kind of insurance that is most beneficial to their needs,” he said.

The athletes are not the only people eligible for exemptions from the tax penalty. Others include people who had insurance through AmeriCorps, recently experienced domestic violence, filed for bankruptcy in the past six months or had incomes below a certain threshold.

“A lot of what the health law tried to do was rein in an in­cred­ibly complicated health system and put some standards on coverage that really never existed,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation.

Young, the discus thrower, had coverage under the elite athlete plan, starting in 2011. After he was injured in 2013, he no longer qualified for the program and was dropped in April of last year, he said.

Chris Barnes, 45, a professional bowler, has been on the USOC health plan for about a year. (Professionals are allowed to compete on the U.S. national team in bowling; the top two athletes in bowling qualify for USOC insurance.)

He has qualified for a second year of coverage that includes his wife and twin sons. The plan provides more generous medical coverage than his family’s former plan. That plan left the family with large medical bills resulting from his son’s diabetes.

Barnes filed a hardship exemption about five or six weeks ago. “I haven’t heard a final determination yet,” he said Friday.

Alice Crites contributed to this report.