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Market Stablization Rules for Individual Health Plans

By benefitlink92293438, Apr 18 2017 10:55PM

The individual health insurance market has been in turmoil the last several years. The ACA requirements have made it practically impossible for health insurers to sustain health coverage due to the unpredictable health plan losses.

CMS (The Centers for Medicare & Medicaid Services) has issued the final Market Stabilization rule to help stabilize individual and small group markets and to help promote more choices in health plans.

Individuals and small groups have faced double-digit premium increases since the Affordable Care Act. There are fewer plans to choose from and a market that continues to be threatened by insurance issuer exits. The CMS rule is designed to provide some relief for patients and issuers.

The final rule made the following changes:

• 2018 Open Enrollment Period for Individual Plans: will start on November 1, 2017 and run through December 15, 2017. This will cause another kink in the bottleneck we currently see with so many group plans and Medicare plans renewing at the same time.

• Reduce Fraud, Waste, and Abuse: This will require individuals to submit supporting documentation for special enrollment periods. They should have been doing this all along.

• Promote Continuous Coverage: Allows insurance companies to require individuals to pay back past due premiums before enrolling into a plan with the same issuer the following year. This addresses one of the problems with individuals not paying after enrolling, but they should also shorten the time they can be late with their payment and still be covered. Currently individuals getting a subsidy have 3 month grace period. Carriers can pend claims after 30 days of non payment.

Ensure More Choices for Consumers: For the 2018 plan year and beyond, the final rule allows issuers additional actuarial value flexibility to develop more choices with lower premium options for consumers, and to continue offering existing plans.

• Empower States & Reduce Duplication: The final rule reduces waste of taxpayer dollars by eliminating duplicative review of network adequacy by the Federal Government. The rule returns oversight of network adequacy to states, which are best positioned to evaluate network adequacy.

Only time will tell if these minor changes will help stabilize the individual market.

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