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November/December 2015 St@teside

All Quiet on the Marketplace Front?

The 2016 Open Enrollment Period (OEP) kicked off on November 1. While there was a series of developments before open enrollment began, such as the closures of several state CO-OPs and major carriers pulling out of a few Marketplaces, the first few weeks of the third annual open enrollment period, which runs through January 31, appear to be going smoothly. 

The reports that have surfaced are largely positive, and many have focused on the Marketplaces’ efforts to increase the public’s awareness of their affordable coverage options and empower consumers to choose health plans that will best meet their needs. Below are a few such spotlights:

  • Covered California recently finished a two-week bus tour of the entire state, which generated buzz for open enrollment and highlighted the services available through the Marketplace.
  • DC Health Link established its Universal Doctor Directory in advance of this OEP, which allows consumers to search for providers by name, location, specialty, and language spoken, and shows which qualified health plans the providers accept. The directory is available in English and Spanish.
  • Access Health CT launched its Health Plan Selection Tool, which helps consumers select a plan based on the individual’s household characteristics, health conditions, and frequency of insurance utilization.
  • Vermont Health Connect, which had been mired in technical glitches since its launch in October 2013 and faced potential shutdown by Governor Peter Shumlin, has made significant progress in improving its system. Vermont is already outpacing last year’s total renewals.
  • NY State of Health, similar to Covered California, is embarking on a statewide mall tour to help raise awareness of the affordable health insurance options available through the Marketplace and enroll New Yorkers in coverage. The tour will stop at eight locations throughout the state between November and January.
  • Washington Healthplanfinder published a self-help toolkit to help consumers navigate the enrollment process, including a guide to help them understand how insurance works.

While the Marketplaces have had their noses to the grindstone, the U.S. Department of Health and Human Services (HHS) released the draft Notice of Benefit and Payment Parameters for 2017. This annual notice sets policies for the health insurance marketplaces and qualified health plans, as well as other health insurance coverage programs. 

This year’s draft notice proposes several key regulatory changes:

  • State-based Marketplaces using the federal platform (SBM-FP), which had been referred to as Supported State-based Marketplaces, would be charged a fee of 3 percent of premium by HHS beginning in 2017 for using the federal platform services.
  • HHS would develop a set of standardized plan options for gold, silver, and bronze plans being sold through in 2017 in an effort to facilitate consumer plan selection. However, insurers would not be required to offer the standardized plans in 2017.
  • The draft notice also proposes enhancing the network adequacy provisions, including requiring states with Federally-facilitated Marketplaces to use quantifiable metrics to assess network adequacy; expanding network adequacy standards to take into account time and distance to providers; and offering protections for individuals who use an in-network facility but have care delivered by an out-of-network provider.

For a more in-depth review of the proposed regulatory changes included in this notice, read this Health Affairs blog post. Comments on the draft notice are due by December 21.