CMS Issues Final Rule To Increase Choices and Encourage Stability In Health Insurance Marketplace

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    The  KISS explanation via Becker's:  

 

    

1. The annual open enrollment period is shortened from three months to six weeks under the final rule. The 2018 enrollment period will begin Nov. 1 and run through Dec. 15. This change will help encourage individuals to enroll in coverage prior to the beginning of the year, according to CMS. Timothy Jost, a law professor at Washington and Lee University and a health law expert, told The Wall Street Journal shortening the open enrollment period may result in fewer younger consumers enrolling in coverage because they historically sign up for coverage toward the end of the enrollment period.

2. The final rule includes stricter requirements for special enrollment periods. Individuals will have to provide supporting documentation for special enrollment periods outside of the annual sign-up period. "It will encourage individuals to stay enrolled in coverage all year, reducing gaps in coverage and resulting in fewer individual mandate penalties and help to lower premiums," said CMS.

3. Individuals will be required to pay overdue premium payments before enrolling in new coverage with the same insurer. CMS said this change is aimed at encouraging individuals to maintain continuous health insurance coverage throughout the year.

4. The final rule gives insurers more flexibility in deciding how much of consumers' costs to cover. This move could result in insurers offering plans with lower premiums but higher deductibles.

5. The federal government will end its review of health plan network adequacy under the final rule. This oversight will be left to the states, as they are best positioned to review network adequacy, according to CMS.

 

    Perhaps that will wake some people up to how skrewed the person using ACA health insurance will be courtesy of HHS Price.   

PRO-LIFE is Affordable Healthcare for ALL .
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(5 Views)

 

 
What does chrono comment 9 mean? I would appear to mean to go to that link for further discussion of this topic but there is nothing at that link and further comments have been posted on this thread?
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@GailL1 wrote:

Actually, several of these changes were started by the Obama Administration back in 2016.

FamiliesUSA June 2016 Acceptable Documentation for Special Enrollment Periods

 

Obama HHS secretary, Sylvia Burwell, cut down on the number of reasons for a Special Enrollment Period and detailed the documentation necessary when applying during this SEP.

 

Concerning the actual dates of open enrollment - the number of days and the timing was always going to be Nov. 1 - Dec. 15 after the program got going good; this recent change just expedites this a little sooner.

 

According to the actual law, PPACA Code of Federal Regulations - Title 45 - Public Welfare

§ 155.410  - Initial and annual open enrollment periods.

(3) For the benefit years beginning on January 1, 2019 and beyond, the annual open enrollment period begins on November 1 and extends through December 15 of the calendar year preceding the benefit year.

 

As to the allowing insurers additional actuarial value flexibility to develop more choices with lower premium options for consumers, and to continue offering existing plans.  No presidence here since the Obama administration added a HDHP choice for those who are less than 30 years old.  This just expands this type of option for people to choose from and existing plans will still be offered too.

 

States have always had the ability to monitor and set standards for plans in their state.  They can review network feasibility better than the feds cause they know their state providers and location, concentration of them better.

 

Somebody that still owes premiums to an insurance company should have to pay them before signing up again with the same insurance company - I think that is part of being an upstanding citizen.


I am at a loss on your post. First who cares when these so called changes started, and you have only stories on limited parts as a source. That is no source since changes happen all the time. What we need less of is people cherry picking out articles they think will fit a post, and more people who know the subject in total. The changes are small and really mean very little at this point. This is like the effort you spent on how important the CO. health care ballot vote was, when in fact most of the time it was barely talked about. I can attest to that since I am in CO quite often. This subject on a scale of 1 (bad) to 10 (good) is about a 2.

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Re: CMS Issues Final Rule To Increase Choices and Encourage Stability In Health Insurance Marketplac

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@GailL1 wrote:

Actually, several of these changes were started by the Obama Administration back in 2016.

FamiliesUSA June 2016 Acceptable Documentation for Special Enrollment Periods. Obama HHS secretary, Sylvia Burwell, cut down on the number of reasons for a Special Enrollment Period and detailed the documentation necessary when applying during this SEP. Concerning the actual dates of open enrollment - the number of days and the timing was always going to be Nov. 1 - Dec. 15 .... 


Too bad you have to defend yourself against nonese comments, Gail. Chronological post 1 on this thread called out all five rule changes released by CMS. You left nothing out. Yet someone claimed

 

  • "You left a little out of your post. How come? Go to the bottom of your support and you will find the main reason some states have large increases. Look at the list. They are states who have not or just expanded medicaid...."

 

I am not exactly sure what the odd word "support" means but if it means the link you provided in chron comment 1, the commenter critizing you is incorrect. PA had PPACA Medicaid expansion all along but simply did it through a Section 1115 waiver, the same way Massachusetts did it years ago (and continues to do it to best of my knowledge). Also the claim that rising premiums would be related to lack of expanded Medicaid coverage makes no sense; that logic would mean there would be more people in the Obamacare pool, which is supposedly what Obamacare needs.

 

Someone else commented about the Kansas hospital that way overbuilt years before PPACA, claiming it was closing because Kansas did not expand Medicaid. The hospital expanded under the old Medicaid rules years before PPACA so if its expansion made any sense then, it should not be going bankrupt now one way or the other

 

Yes it is true that you did not say

 

  • "... in Pa. rates will increase 3% due to a premium assessment by the state to add money to the claims guarantee fund which just about went broke after a large insurer went broke with its long term care insurance and the state is now paying those claims."

 

But since that information -- if it is true -- is not in the CMS press release, how could you be criticized for leaving it out? It also looks like the people on Medicaid in PA are (all?) being put in plans that work like public Part C of Medicare. The same is happening here in Massachusetts, even more so under our latest Section 1115 waiver (our fifth or sixth waiver going back to about 1995). How come the lefties aren't screaming about that the way they scream about moving to that sort of coverage in Medicare?

 

On the other hand, there are three sentences from the CMS press release that you left out (probably because you did not want to offend the snowflake commenters on this thread):

 

  • "Approximately one-third of counties in the U.S. have only one insurer participating in their exchange for 2017.
  • "Five states have only one insurer participating in their exchange for 2017.
  • "The premium for the benchmark second-lowest cost “silver plan” on Healthcare.gov increased by an average of 25 percent from 2016-2017."

 

Given these facts, the easy answer to your first comment's question is "The whole thing is going to collapse (it's close already) and then they can start over."

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Actually, several of these changes were started by the Obama Administration back in 2016.

FamiliesUSA June 2016 Acceptable Documentation for Special Enrollment Periods

 

Obama HHS secretary, Sylvia Burwell, cut down on the number of reasons for a Special Enrollment Period and detailed the documentation necessary when applying during this SEP.

 

Concerning the actual dates of open enrollment - the number of days and the timing was always going to be Nov. 1 - Dec. 15 after the program got going good; this recent change just expedites this a little sooner.

 

According to the actual law, PPACA Code of Federal Regulations - Title 45 - Public Welfare

§ 155.410  - Initial and annual open enrollment periods.

(3) For the benefit years beginning on January 1, 2019 and beyond, the annual open enrollment period begins on November 1 and extends through December 15 of the calendar year preceding the benefit year.

 

As to the allowing insurers additional actuarial value flexibility to develop more choices with lower premium options for consumers, and to continue offering existing plans.  No presidence here since the Obama administration added a HDHP choice for those who are less than 30 years old.  This just expands this type of option for people to choose from and existing plans will still be offered too.

 

States have always had the ability to monitor and set standards for plans in their state.  They can review network feasibility better than the feds cause they know their state providers and location, concentration of them better.

 

Somebody that still owes premiums to an insurance company should have to pay them before signing up again with the same insurance company - I think that is part of being an upstanding citizen.


* * * * It's Always Something . . . Roseanne Roseannadanna
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Quotes by right-wing ideologues stand out like a sore thumb. The ACA has not created problems in our healthcare system. Any person describing it as such has an axe to grind. It seems that Ms Verma is just another Trump appointee who is "...often described as a behind-the-scenes Republican operative. Regarded as smart and talented, she is also considered single-minded and conservative...Verma’s best known work used a little-known provision of federal health law to push conservative ideas through despite the Obama administration."

 

Sorry, but from the Donald's previous appointments, we know what to expect from such a person in a position of authority. At least they're predictable.

 

https://www.theguardian.com/us-news/2016/dec/04/seema-verma-trump-centers-medicare-medicaid-cms

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    And another hospital in Kansas is going into bankruptcy.    Republicans will be dancing in the streets- more people will die when there is no access, period.    Price will celebrate - the need to send money to Kansas will be reduced when more people die - because that is his wet-dream via Cap based on # of people.  

     The reduction of days to sign up is away to reduce the number of people to take action.   Expect the Fed website to mysteriously not function and that will be no excuse.

      Reduce Fraud / Waste - by requiring more documentation, aka death by paper cuts.     G must have missed all the rules that allow people to be human.    That is similar to Ryan:   people who are in jail ( not charged, not guilty) will not be elgible for ACA insurance coverage.     So increasing the police state ( Sessions wet dream of police state) can be used to make people inelgible.

      YEA!!!!!!!!!!!!!!!!!!   let' have garbage policies that don't actual cover much - aka back to the bad old days pre ACA.

 

      Need I continue?    Yes, I responded to Price hate fest but only being a singular individual rarely influences those in DC, especially the current Admin of Hate.  

PRO-LIFE is Affordable Healthcare for ALL .
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@GailL1 wrote:

Good Grief, john258, I posted the changes and asked what people thought.

I am sure that we all have different views on all the problems which the ACA has - including some with the insurers and how states administer their plans including premiums.

 

Yes, insurers were asked what problems they were having with the overall system or what suggestions they had to make it better- enrollment, people paying, plan design, etc.

 

I think these are just a few changes which could make a difference for the insurers and I don't think they are outlandish.

 

Specifically, I was asking if those here thought these changes might make any difference.

 

As to your criticism of my knowledge - Talk to somebody else, I will not respond to your post any longer.  I have had enough.  Good Bye


You can not just post an article on the new rules with out covering the full problem and how the rules will interact with the program. I gave a quick overview on some of the main causes of high rates so people can put that into their thoughts when answering. That way you will get some good discussion going. There needs to be some back ground on the new rules as what they were created to do, and who suggested them. With out that you can not have a discussion which means anything. An example is Open enrollment (rule 1 in your support). The Insurance Cos. felt the open enrollment period was to long and there were some people who would only buy or cancel coverage when they found out from a Dr. that they would or would not need insurance. They were selecting against the carrier. ( That is why the pre ex was created, and the ACA did away with it since all were to be covered so that ended selecting.) You can not zero in on just one thing which is interlinked to quite a few parts of the whole.

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Good Grief, john258, I posted the changes and asked what people thought.

I am sure that we all have different views on all the problems which the ACA has - including some with the insurers and how states administer their plans including premiums.

 

Yes, insurers were asked what problems they were having with the overall system or what suggestions they had to make it better- enrollment, people paying, plan design, etc.

 

I think these are just a few changes which could make a difference for the insurers and I don't think they are outlandish.

 

Specifically, I was asking if those here thought these changes might make any difference.

 

As to your criticism of my knowledge - Talk to somebody else, I will not respond to your post any longer.  I have had enough.  Good Bye


* * * * It's Always Something . . . Roseanne Roseannadanna
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