Details on President Trump’s plans for an ACA repeal and replacement are finally coming to light. In a new proposed rule, the stabilization of the exchange is placed at the forefront while the GOP continues to refine the repeal and replacement plan. There are many parts to the rule, but here are some takeaways:
Possibly Less Benefits
Those providers who participate in the Marketplace are given more leeway in the scope of coverage under this proposed rule. Plan levels like platinum, gold, silver and bronze coverage are mandated by the ACA and each have an actuarial value where the “de minimis” range between the plans is about +/-2%. This proposed rule changes that, where plans can be +2% or -4%, the latter falling significantly below the actuarial value of a current bronze plan.
Consumers Must Pay Their Premium Debts
Consumers who fail to pay their premiums and are dropped from their insurance must pay all of the premium payments owed to the insurance company before re-enrollment happens for the next year. If they aren’t paid, the provider can deny coverage.
Stringent Special Enrollment Periods
For special enrollment periods, eligibility must be confirmed by the HHS prior to enrolling. This is especially true for federal-run exchanges. Further, stricter guidelines for eligibility will be placed upon these special enrollment periods. Typically relocations and marriages are two circumstances, but going forward the allowance for these circumstances will be limited.
Shortened Open Enrollment Periods
The current open enrollment period is 11/1-1/31. The proposed rule changes that for plan years starting on 1/1/18 to the following: 11/1-12/15. While this was initially proposed for 2019 plans, that’s bumped a year. The reasoning is that this timeline aligns better with both employer-sponsored healthcare and Medicare.
More Power To The States
States will now have the power to determine the quantity/quality of network providers in their area without federal intervention.
Comments on this proposed rule are due in March, and the GOP is hopeful this could be fast-tracked in the same month. Providers will be given ample time to implement these changes as they happen, with room for transition.
