The Centers for Medicare and Medicaid Services (CMS) has issued final regulations that will be effective June 19, 2017. The purpose of the regulations is to help stabilize the Health Insurance Marketplace, provide more flexibility to states and insurers, and provide individual consumers with more coverage options.
“While these steps will help stabilize the individual and small group markets, they are not a long-term cure for the problems that the Affordable Care Act has created in our healthcare system,” according to CMS Administrator Seema Verma. After the American Health Care Act was stopped in its tracks, there is a lot of anticipation about what will happen next (check out our recent blog on this topic). One thing is for sure: more changes are sure to be expected under the new Trump Administration, but for now let’s see how the new rules will affect us.
Shortened open enrollment period
The open enrollment period will be shortened from three months to six weeks. This will closely align with enrollment for Medicare and the private market. Enrollment will begin November 1, 2017 and end December 15, 2017 for coverage beginning January 1, 2018. Our team at Take Command Health will be working overtime to help our customers meet the deadline for this shortened sign up period, helping them make smart choices with the options available.
Greater control over special enrollment periods
Beginning in June, individuals will have to provide documentation proving they qualify for special enrollment when applying for coverage outside the open enrollment period. Typical events that qualify for Special Enrollment Periods include: marriage, divorce, moving, having a child, or losing coverage. In addition to providing preapproval documentation, newlyweds are required to have at least one person of the couple provide proof of coverage lasting at least one day in the prior two months of the nuptials. This prior coverage rule could prove troublesome for couples who could not afford health care coverage as individuals. All of this documentation can be very confusing - especially in the midst of a big life event - so Take Command Health will be standing buy to help guide those who qualify for Special Enrollment get their ducks in a row.
Promote continuous coverage
The final rule will allow insurance companies to collect past due premiums from the previous 12 months before issuing new policies. This means that if you want to go back to the insurance company you had last year, but didn’t pay your premiums for two months, you will owe two months of premiums before the insurance company will issue your insurance policy. This rule is meant to discourage consumers from electing insurance coverage and canceling after an expensive surgery is completed.
More choices for consumers beginning in 2018
Under the Affordable Care Act, there were four main brackets of plans: bronze, silver, gold, and platinum. The final regulation provides insurers the flexibility to adjust their plans offered in the marketplace. The plans will still stay within the tier brackets but insurers will have the ability to adapt the offerings within each bracket. This will result in more options for consumers and, most likely, plans with lower monthly premiums but higher annual deductibles (which may appeal to more consumers, especially healthy ones). More choices only helps consumers if they make the 'right' choice. Our website is specially designed to recommend plans based on your specific needs, your doctors and your budget.
Empower states and reduce duplication
States will be responsible for reviewing plans that are within their jurisdiction to ensure that they have an adequate network to work in their state. This will eliminate further federal government review which has been redundant in the past and a waste of taxpayers dollars.
Tracking policy changes at Take Command Health
Health insurance consumers in 2017 were faced with double digit premium increases, less plans to choose from, and insurance carriers exiting the market. We are excited to see what changes these final rules will bring to the marketplace for 2018. Hopefully we will see better plan options for our customers to choose from with the networks of doctors they need. In the meantime, our team at Take Command Health is tracking these policy changes closely to share the latest updates with you and we are here to help you make the smartest choices for your health plans in this new health insurance climate. Let us help you stay up-to-date!
I wrote this blog because I love helping people decode confusing insurance jargon and understand the fine print. I'm a licensed health insurance professional and specialize in simplifying health insurance for individuals and small businesses. My QSEHRA articles have been featured regularly on Accounting Today, Accounting Web, HRWeb, and other industry publications. I'm also a member of Take Command Health's client success team and a full-time mom. Learn more about me and connect with me on our about us page. Thanks!