CMS Seeks to Increase Health Insurance Options for 2018


Proposed rule would improve individual and small group health insurance options.

This week, the US Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would take effect in 2018 to improve options for individuals seeking health insurance coverage.

The rule proposes multiple reforms that will likely result in the stabilization of the individual and small group health insurance market in order to protect patient access, according to a press release.

The proposed rule would alter the special enrollment periods, open enrollment period, guarantee availability, network adequacy rules, essential providers, and value requirements. The CMS also announced changes to the qualified health plan certification timeline.

Under the new rule, pre-enrollment verification for eligible individuals who enroll during the special enrollment period will expand. The expansion would ensure that special enrollment periods are available to eligible individuals, but they will also be required to provide documentation that confirms their need, according to the CMS.

This is a practice that is currently implemented among numerous commercial insurers, and is expected to lower premiums and abuse, the press release noted.

The rule also will allow insurers to collect unpaid premium costs prior to renewing coverage for the next year. Insurers will have greater flexibility to provide patients with additional coverage options by adjusting the minimal coverage range.

When reviewing qualified health plans, the new rule proposes to defer to state reviews to assess network adequacy, since states are in the best position to ensure their residents can access high-quality networks, according to CMS.

CMS also plans to revise the timeline for the qualified health plan certification and rate review process for next year, which would allow for additional time to implement changes that are finalized before 2018. This will also give insurers flexibility, and increase the options offered to patients.

Additionally, CMS proposes to shorten the annual open enrollment period. For 2018, the agency proposes a period from November 1, 2017 to December 15, 2017. This alteration will align the marketplaces with employer-sponsored plans and Medicare, and can lower costs by reducing adverse selection, according to the press release.

“Americans participating in the individual health insurance markets deserve as many health insurance options as possible,” said Patrick Conway, MD, acting administrator of the CMS. “This proposal will take steps to stabilize the Marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options. They will help protect Americans enrolled in the individual and small group health insurance markets while future reforms are being debated.”

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