Insurance Exchanges

This rule finalized a slew of regulations related to the structure and operations of Medicaid, CHIP, and exchanges under the ACA. These include eligibility and enrollment requirements for qualified health plans and insurance affordability programs (Medicaid, CHIP, APTCs, and Basic Health Plans). It also detailed minimum standard requirements for Alternative Benefit Plans and changes to eligibility notices and appeals for Medicaid and CHIP. Additionally, it updated the criteria for verification of eligibility and enrollment in employer-sponsored insurance.

On Friday, July 28, the Centers for Medicare & Medicaid Service (CMS) posted Marketplace Experience and QHP Experience Enrollee Satisfaction Surveys. The survey Paperwork Reduction Act (PRA) packages are available for public comment through August 27.

This analysis compares the population most likely to enroll in the ACA's nongroup exchanges to those who now have employer coverage, focusing on characteristics related to health risks. If the populations are comparable, unsubsidized premiums in the reformed nongroup market should be set at reasonable levels once reform is fully phased-in. While individuals with higher-than-average health care needs may be somewhat more likely to enroll in the nongroup market in the first year, once past the transition period, the health characteristics of nongroup enrollees can be expected to be quite similar to those with employer-based insurance.

This set of instruments released by the Centers for Medicare and Medicaid provides guidance on the methodology and surveys that CMS will use to assess enrollee satisfaction with the Marketplace and QHPs.

This brief, prepared by Wakely Consulting Group, analyzes different options for premium rating methods for the Small Business Health Options Program (SHOP) Exchange.  The details of the billing/employer contribution approaches are explored and insights are given into the benefits and challenges of each method.  A key challenge in promoting employee choice in the SHOP is developing premium rating methods that do not discriminate against older employees, but that will support (a) employee choice of health plans based on value (including premiums), (b) a defined employer contribution, (c) a fair allocation of premiums among issuers, and (d) a premium invoice which employers can understand. This brief explores six options that SHOP exchanges can consider for resolving these issues.