CMS Issues Finalized Rule to Encourage Market Stability

With Open Enrollment right around the corner, we wanted to take a moment and address some of the changes we will see taking place this year. Below is an outline of changes created by a CMS-issued Final Rule (CMS-9929-F) that will go into effect on June 19, 2017, 60 days after the initial publication in the Federal Register on April 18, 2017.

 

The rule addresses:

  • Standards related to special enrollment periods (SEPs)
  • Guaranteed availability
  • Timing of AEP and OEP for 2018
  • Standards related to network adequacy and essential community providers for qualified health plans
  • Actuarial value requirements
  • SEPs

Health insurers frequently raise the issue of the abuse and misuse of SEPs, which may enable sick enrollees not entitled to an SEP to join plans outside of open enrollment. To combat this perceived abuse, CMS is requiring pre-enrollment verification of all SEP enrollments for states served by HealthCare.gov.

 

Open Enrollment
The open enrollment period for 2018 has been shortened to run from November 1 through December 15, 2017. While CMS states that this change will reduce opportunities for adverse selection, it will likely create significant challenges for brokers who are attempting to help a large, diverse book of business in a shorter period of time.

 

Guaranteed Availability
CMS is changing its interpretation of the guaranteed availability requirement to allow insurers to apply a premium payment to an individual’s past debt owed for coverage from the prior 12 months before applying the payment toward a new enrollment. This change is intended to encourage individuals to maintain continuous coverage throughout the year. Previously, insurers have provided anecdotal examples of individuals who paid premiums for 2–3 months while obtaining services, and then subsequently stopped paying their premiums, allowing their coverage to lapse. These individuals later re-enrolled with no consequence during the following OEP.

 

Network Adequacy
CMS will defer to individual state review of network adequacy, which will eliminate a duplicative review by the federal government.

 

Actuarial Value Requirements
CMS issued changes to the de minimis allowable variation in the actuarial value of a health plan. This change is intended to give insurers greater flexibility in creating lower cost plans, in an effort to attract younger and healthier enrollees.

Cornerstone will continue to provide updates on the implementation of these rule changes. Brokers should be aware that, while these changes are intended to stabilize the individual market, a great deal of uncertainty still surrounds the administration’s intent to pay and preserve cost-sharing subsidies.

CMS Issues Pre-Enrollment Verification Process for SEP Eligibility

On April 18, 2017, CMS released Patient Protection and Affordable Care Act; Market Stabilization, which finalizes changes designed to stabilize the individual and small group markets. This final rule amends standards regarding SEPs, guaranteed availability, and the timing of OEP for 2018.

Beginning in June 2017, HHS will implement a pre-enrollment electronic verification process for SEP in all states that use the Healthcare.gov  platform. The pre-enrollment verification process will fall into two phases:

  • Phase 1 (June 2017): CMS will verify SEPs, including Loss of MEC and Permanent Move
  • Phase 2 (August 2017): CMS will verify SEPs including Marriage, Medicaid/CHIP Denial, and Addition of a Dependent through Birth, Adoption, Foster Care, or Court Order

This pre-enrollment verification process is designed to promote continuous coverage, protect the risk pool, and stabilize rates.

Once the enrollee completes the application and makes a plan selection, they will have 30 days to provide documentation and prove eligibility.

Questions? Contact a Cornerstone expert today.

Read through Cornerstone’s write up of the final rule here.

 

RESOURCES

Market Stabilization Final Rule

Medical Mutual Updating Step Therapy Programs Beginning July 15

Medical Mutual’s step therapy programs for prescription drugs, which promote clinically effective alternative drugs to improve cost savings and quality of care, will be updated effective July 15, 2017. In early May, Express Scripts will send out a letter to members who have filled a alternative drug prescription in the last month about the new requirements, which will be specific to the drug(s) that the member takes. Medical Mutual expects that the updates will effect up to 9,600 members.

These updates do not apply to Medicare Advantage and Medicare Supplement plans.

 

Not appointed with Medical Mutual? Contact your Cornerstone representative today to get started!

RESOURCES

Updates to Step Therapy Programs Begin July 15, 2017; Express Scripts to Notify Members

Anthem Releases Updated Medicare Supplement Rates

Anthem has released their updated Medicare Supplement rates effective July 1, which includes the introduction of Plan G to their portfolio. Like Plan F, Part G covers Medicare Part B Excess Charges, however, it does not cover the annual Part B deductible. And remember, all Modernized Anthem Medicare Supplement members are also now eligible for the Silver Sneakers Fitness program which offers members a basic membership at no extra cost*.

The new rates for Anthem’s Medicare Supplement plans are below.

Please be aware that with this release Anthem has also updated their Medicare Supplement application.  The new application as well as the updated kits will be available to order through custom point on May 16. Old applications will may be rejected.

Interested in getting appointed with Anthem? Contact your Cornerstone representative today.

 

RESOURCES:

Ohio Anthem BCBS July 2017 Supplemental Rates

 

*SilverSneakers is a value-added program. It is not insurance and not part of the Medicare Supplement insurance plans. It can be changed or withdrawn at any time.

 

Have you registered for Senior Expo 2017?

IRS Announces 2018 Indexing Adjustments

The IRS recently announced the 2018 indexing adjustments for two percentages under the ACA, as well as a reminder that the required contribution percentage used to determine whether individuals are exempt from individual shared responsibility penalties also decreased to 8.05 percent for 2018. The first percentage under the ACA, which is the percentage required to determine whether employer-sponsored health coverage is “affordable” for purposes of employer-shared responsibility, has decreased from 9.69 percent in 2017 to 9.56 percent for 2018. The second percentage, which is the percentage required to determine the amount individuals eligible for premium tax credits must contribute toward the cost of Exchange coverage, will decreases slightly.

For more information, refer to the full text of the announcement below.

Questions? Contact your Cornerstone representative for answers!

 

RESOURCES

Refundable credit for coverage under qualified health plan—indexing adjustments.

HSA Contribution and Coverage Limits for 2018 Announced

The IRS recently released Revenue Procedure 2017-37, which outlines the 2018 cost-of-living contribution and coverage adjustments for HSAs, as required under Code Section 223(g). The procedure also includes the minimum deductible and maximum out-of-pocket expenses for the high-deductible health plans (HDHPs).

According to the procedure, the amount that individuals may contribute to their HSAs for self-only coverage will increase by $50 (from $3,400 in 2017 to $3,450 in 2018) in 2018, while HSAs linked to family coverage will rise by $150 (from $6,750 in 2017 to $6,900 in 2018). Rate changes reflect cost-of-living adjustments.

 

Contribution and Out-of-Pocket Limits for Health Savings Accounts and High-Deductible Health Plans
2018 2017 Change
HSA contribution limit (employer + employee) Self-only: $3,450
Family: $6,900
Self-only: $3,400
Family: $6,750
Self-only: +$50
Family: +$150
HSA catch-up contributions (age 55 or older)* $1,000 $1,000 No change**
HDHP minimum deductibles Self-only: $1,350
Family: $2,700
Self-only: $1,300
Family: $2,600
Self-only: +$50
Family: +$100
HDHP maximum out-of-pocket amounts (deductibles, co-payments and other amounts, but not premiums) Self-only: $6,650
Family: $13,300
Self-only: $6,550
Family: $13,100
Self-only: +$100
Family: +$200
* Catch-up contributions can be made any time during the year in which the HSA participant turns 55.
** Unlike other limits, the HSA catch-up contribution amount is not indexed; any increase would require statutory change.


RESOURCES

Revenue Procedure 2017-37

IRS Sets 2018 HSA Contribution Limits

 

Questions? Contact your Cornerstone representative today for more information!

Aetna Will Exit Obamacare Individual Insurance Market (Virginia)

Aetna will exit the Obamacare individual insurance market in Virginia because of the “financial risk” and “growing uncertainty in the marketplace.”  The move only affects individual plans sold on and off the federal Obamacare exchange at HealthCare.gov.

T.J. Crawford, Aetna’s spokesman, said in an email, “Despite significantly reducing our exchange footprint, our individual commercial products could potentially lose more than $200 million in 2017.”

Source: CNBC (http://www.cnbc.com/2017/05/03/aetna-will-exit-obamacare-markets-in-virginia-in-2018.html)

Customers covered by Aetna through employers or Medicaid and Medicare Advantage plans will not be affected by this change.

 

Questions? Contact your Cornerstone representative today.

RESOURCES

Aetna Will Exit Obamacare Markets in Virginia in 2018

Aetna to Exit Virginia Obamacare Individual Insurance Market

GOP Health Care Bill Passed by the House

A Republican-drafted health care bill that would eliminate many provisions of the Affordable Care Act was passed by the House with a 217–213 vote on Thursday. The bill still awaits the Senate’s final approval.

The vote came only 6 weeks after House leaders failed to pass an earlier version of the bill. The bill includes last-minutes amendments that were written to appeal to the most conservative House Republicans and eliminates tax penalties for people that do not have health insurance. The bill will also offer tax credits between $2,000 and $4,000 per year, depending mainly on age, and provides $8 billion for states to set up high-risk pools to cover those with pre-existing conditions who are unable to find coverage on the open market. A number of Republicans in the Senate have expressed concern over how the bill would affect states that expanded Medicaid and how much it would drive up premiums for seniors.

The bill is expected to be significantly altered by the time it reaches the Senate chamber.

This is a developing story. We will continue to provide details as they come.

RESOURCES

House Passes GOP Health Care Bill

House Passes Measure to Repeal and Replace the Affordable Care Act

SAVE THE DATE: 2017 NW Ohio CE Training Days

Businessman hand touching SAVE THE DATE tab on virtual screen , business concept , business ideaWHERE*: Toledo: 4444 Keystone Drive, Suite F | Maumee, OH | 43537
Lima: 3745 Shawnee Road, Suite 104 | Lima, OH | 45806

*Please RSVP to Jenni Henry no later than 2 weeks prior to the event to reserve your space.

WHAT: Four (4) hours of CE available each day with product updates and training from our carrier representatives. There is a 15-minute break between each speaker so you can check emails/phone calls.


 

 

Information for the July 18th (Lima) and July 19th (Toledo) training days will be provided closer to the date of the event.

Contact your Cornerstone representative today for more information.

Medical Mutual Making Claims Adjustments Involving University Hospital Providers

After discovering that two pediatricians at University Hospital Medina Health Center were incorrectly loaded into the SuperMed network, Medical Mutual is working to update the directory so that the 70 members whose in-network claims were rejected will receive revised Explanation of Benefits statements with the correct claim information. Members who already submitted payment for those claims may be entitled to a refund.

For more information, contact your Cornerstone representative today.

RESOURCES

Medical Mutual Broker Update — May 3, 2017