April 2017 HHS Rule and Other Proposals to Stabilize the Health Insurance Marketplaces

April 13, 2017

A screenshot of under a magnifying glass.Health plans are now determining whether to offer coverage in the Marketplace this fall and if so, which products and rates to offer. While there is continuing discussion about repealing and replacing the Affordable Care Act (ACA), legislative action does not appear imminent. To assure a robust ACA market, many have advocated for “repairs” to the ACA. These potential repairs to the ACA range from the addition of a “public option” in areas with low competition, to fixing the “family glitch,” to eliminating the Cadillac Tax.

In this fact sheet, we highlight some of the potential repairs to ACA that are currently in discussion and are particularly relevant to health plans as they decide whether or not to participate in the 2018 Marketplace.

The potential repairs we review are:

  • Fully fund cost-sharing reduction
  • Extend and fully fund the reinsurance program
  • extend and increase funding for risk corridors program
  • Require pre-enrollment verification by HHS to verify eligibility for special enrollment periods
  • Limit grace period for premium payments
  • Shorten open enrollment period
  • Allow increased variation in actuarial value requirements

The fact sheet also presents a timeline for insurer Qualified Health Plan (QHP) filings. On Feb. 17, 2017, the Centers for Medicare and Medicaid Services (CMS) announced plans to revise its schedule for the 2018 Qualified Health Plan (QHP) filing and rate review process for insurers offering coverage on the federally-facilitated Health Insurance Marketplaces created under the Affordable Care Act (ACA). This change is intended to give insurers more time to determine their participation and prepare their 2018 filings.