CMS Proposes Improvements for 2017 Marketplace

November 23, 2015 Robert Sheen Health Insurance Marketplace

The Centers for Medicare & Medicaid Services (CMS) issued proposals for companies that will participate in the Health Insurance Marketplaces in 2017 that are aimed at improving the consumer experience, both when individuals shop for health insurance and when they use it.

With millions of people turning to the Marketplace health coverage, said Kevin Counihan, CEO of Health Insurane the Marketplaces, the goal of the proposed changes is to “make the Marketplaces work even better so that consumers will benefit from choice and competition.”

The proposal asks states to establish minimum standards for adequate provider networks, subject to criteria CMS will establish.

CMS is evaluating additional ways to help consumers make informed decisions about the adequacy of provider networks, including ways to indicate whether or not a plan has a broad number of doctors and health facilities.

To make it easier for consumers to compare plans, CMS is proposing to give issuers the option of offering plans with standardized options such as cost-sharing. Insurers could also continue to offer plans with more variable plan designs, so consumers can choose the plan that’s right for them.

In an effort to reduce surprise expenses to consumers, CMS is seeking comment on a requirement that health plans include an estimate of expenses for out-of-network services performed at an in-network facility without advance notice.

For instance, if a patient who had surgery at an in-network facility finds out later that their anesthesiologist was not part of the health plan’s network, cost-sharing charges for the anesthesiologist’s services would count toward the out-of-pocket maximum. Currently, these out-of-network cost-sharing charges do not count toward the out-of-pocket maximum.

Recognizing that many consumers need help understanding and using their coverage after they enroll, CMS is asking for comment about expanding the role of Navigators for such issues as eligibility appeals and applying for exemptions.

The proposed rule would also increase options for employees in the federal Small Business Health Options Program (SHOP) for plan years beginning in 2017 and beyond, to give employers more choices as they look for coverage that best suits their employees.

Currently, employers participating in the federal SHOP Marketplace can offer their employees either one health plan and/or one dental plan or all health and dental plans across one metal tier. Under the proposal, employers would be able to offer all plans across all levels of coverage from one insurance company.

Other issues for which CMS is seeking comments include:

• Streamlining direct enrollment so that customers can more easily use websites of agents and brokers;
• Options to transition consumers more smoothly from Marketplace coverage to Medicare;
• Updating the risk adjustment formula with current data;
• Improving the child age rating curve to more accurately price premiums; and
• Dates for the 2018 Open Enrollment period.

A detailed list of the proposals is available online.

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