Proposed 2018 Payment Notice Targets Exchange Stability

Added on Sep 22, 2016

Proposed 2018 Payment Notice Targets Exchange Stability
From Industry Edge September 2016

Amid growing uncertainty regarding the Affordable Care Act (ACA) health insurance exchanges, the Centers for Medicare & Medicaid Services (CMS) recently released its proposed 2018 payment notice, which seeks to stabilize the exchanges. The proposal includes changes to the risk adjustment program, new rules for special enrollment periods and more latitude for insurers to design their own plans.

Over the past several months, several high-profile insurers have opted out of participation in the exchanges, also known as marketplaces, and higher proposed premiums have prompted questions about the viability of exchanges despite CMS pushback. One of the proposed provisions is designed to make it easier for a health insurer that leaves an exchange to return sooner than previously expected.

Of particular interest to health insurers are the proposed changes associated with the ACA’s risk adjustment program. Under the program, insurers may receive extra compensation to offset the costs of covering sicker enrollees, and some may also pay back into the program, if they cover healthier individuals. Both provisions could help boost the number of insurers who sell health plans through an exchange. Additionally, the proposed changes promise to make risk calculation easier under a standardized process across Healthcare.gov, and to tighten some measures—especially those involving special enrollment periods—that have contributed to increased premiums.