Insurance Exchanges

Due to technical issues in establishing automated eligibility and enrollment functionality, Marketplaces have had difficulty in providing timely eligibility determinations to applicants and enrolling qualified individuals in Qualified Health Plans (QHPs) during the open enrollment period for the 2014 coverage year. Such a circumstance may be considered an exceptional circumstance for individuals who were unable to enroll in a QHP through the Marketplace due to these issues. This bulletin provides guidance on the availability of advance payments of the premium tax credit and cost-sharing reductions on a retroactive basis to an issuer, and clarifies the attendant responsibilities of the QHP issuer in this circumstance.

This is the fourth in a series of issue briefs highlighting national and state-level enrollment-related information for the Health Insurance Marketplace. This brief includes data for states that are implementing their own Marketplaces, and states with Marketplaces that are supported by or fully run by the Department of Health and Human Services. This brief also includes updated data on the characteristics of persons who have selected a Marketplace plan (by gender, age, and financial assistance status), and of the plans that they have selected (by metal level); along with additional data on the characteristics of people who have selected plans in the FFM and the plans they have selected.

The Centers for Medicare and Medicaid Services (CMS) is releasing this draft Letter to Issuers in the Federally-facilitated Marketplaces (FFMs). This Letter provides issuers seeking to offer Qualified Health Plans (QHPs), including stand-alone dental plans (SADPs), in an FFM and/or Federally-facilitated Small Business Health Options Program (FF-SHOP), with operational and technical guidance to help them success fully participate in the Marketplaces. Comments on this draft are due by February 25.

This is OPM’s annual call for applications and recertification submissions from prospective and current Multi-State Plan (MSP) issuers for the contract term beginning January 1, 2015. The MSP Program was created to bring choice and competition to the Health Insurance Marketplace. The Program’s charge is to make available at least two quality, affordable MSP options in the Marketplace in every State and the District of Columbia. In the inaugural year, OPM certified more than 150 MSP options that are now available to consumers in 30 States and the District of Columbia. OPM also certified MSP options for the Small Business Health Options Program (SHOP) in four States and the District of Columbia. For 2015, OPM’s goal is to expand MSP coverage to at least five additional States, and to add one or more new MSP issuers or groups of issuers.

This is the third in a series of issue briefs highlighting national and state-level enrollment-related information for the Health Insurance Marketplace. This brief includes data for states that are implementing their own Marketplaces, and states with Marketplaces that are supported by or fully run by the Department of Health and Human Services. This brief also includes some preliminary data on the characteristics of persons who have selected a Marketplace plan by gender, age, and financial assistance status, and of the plans that they have selected by metal level.