We haven’t even gotten through the 2018 open enrollment season yet, but the Centers for Medicare and Medicaid Services (CMS) has already proposed rules that would impact health insurance markets for 2019. Each year, CMS issues a Notice of Benefit and Payment Parameters which explains various rules, inflation adjustments and other changes that will occur with the implementation of the Affordable Care Act (ACA). CMS recently released guidance for the 2019 year, of which a high-level overview has been provided:

 

Essential Health Benefits. States will be granted more flexibility when determining the fine print details of what’s included with each essential health benefit. For 2019, states will have the option to choose a benchmark essential health benefit plan that any other state used for the 2017 plan year. States may also choose to just replace one or more of the ten essential health benefit categories with one that was filed by another state for the 2017 plan year. As a third new option, states may select a new benchmark plan based on essential health benefits that would be covered under a typical employer plan. 

 

Out-of-Pocket Maximum. The out-of-pocket maximum for non-grandfathered health plans has been proposed to be $7,900 for single coverage and $15,800 for family coverage. 

 

Standardized Health Plans. The new CMS guidance proposes to eliminate the standardized health plan options available on the Health Insurance Marketplace. They cite that these plans lack innovation. 

 

Rate Reviews. Currently, any premium rate increases of 10% or more require a review from a state or federal regulatory agency. Due to high premium rate increases over recent years, the new CMS guidance proposes a change which would require a rate review for premium increases of 15% or more starting in 2019. 

 

SHOP Exchanges. As suspected, CMS is proposing to take the SHOP Exchange process mostly offline from healthcare.gov. Employers who wanted to enroll through the SHOP Exchange could do so directly with an insurance producer or carrier participating in the SHOP Exchange. This has actually been proposed to take effect as of January 1, 2018. 

 

To access all of the proposed rules for 2019, please click here.