2018 Brings New Changes To ACA Exchange
While the country still awaits the final cues for the U.S. Senate’s take on healthcare reform, more updates arrive for the coming year.
The Centers for Medicare & Medicaid Services (CMS) released a final rule relating to the stabilization of the ACA Exchange for 2018. To facilitate such stabilization, the final rules seek to provide more “incentives” for individuals to maintain coverage while dis-incentivizing those who enroll only after discovering the need for medical services.
For one, the open enrollment period will be shortened—ending on December 15, 2017 as opposed to January 31, 2018, unless approved for special enrollment. This move aims to time the enrollment period end with the start of plans for the new year. In addition, the special enrollment prerequisites will be stricter, with period changes and new rules for verification in a stated effort to prevent the abuse of these special enrollment periods. In order to re-enroll for a plan in the upcoming year, providers have the option to demand all unpaid premiums up front prior to accepting enrollment.
The de minimis variation will also be altered with regard to the actuarial values of the metal-based ranking system for coverage under the Affordable Care Act. This can possibly decrease the scope of coverage for the same premium cost. And finally, the minimum essential community provider will be lowered from 30 percent to 20 percent, with revisions to the reviewing process for sufficient options within any given network.
What this means for Americans is that while the existing Affordable Care Act sought to provide affordable healthcare coverage, the final rules implicate the risk of reduced coverage at the same cost. Further, tighter eligibility requirements may result in the reduced enrollment numbers. While the ACA is the law of the land for the foreseeable future, will these new provisions harm the ACA’s goal of affordable healthcare for all?
To read the final rule, click here.
One thing remains true and that is employers must still comply with the ACA’s Employer Mandate.
Under the ACA’s Employer Mandate, Applicable Large Employers (ALEs) (organizations with 50 or more full-time employees and full-time equivalent employees) are required to offer Minimum Essential Coverage (MEC) to at least 95% of their full-time workforce (and their dependents) whereby such coverage meets Minimum Value (MV) and is Affordable for the employee or be subject to Internal Revenue Code (IRC) Section 4980H penalties.
The IRS is currently issuing Letter 226J penalty assessments to employers identified as having failed to comply with the ACA’s employer mandate for the 2017 tax year. If you’re organization has received one, review this guide on how to respond.
To learn more about ACA compliance in 2021, click here.
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