Insurance Exchanges

With October's open enrollment for exchanges drawing near, a key issue that remains is premium rates for health plans sold in the exchanges. This map tracks states that have released rate information filed by carriers interested in selling plans in health insurance exchanges in both the individual and small group markets.

This final rule outlines Exchange standards with respect to eligibility appeals, agents and brokers, privacy and security, issuer direct enrollment, and the handling of consumer cases. It also sets forth standards with respect to a State’s operation of the Exchange and Small Business Health Options Program (SHOP).

This educational slide deck, prepared by Manatt Health Solutions, provides detailed information on Advance Premium Tax Credits (APTCs) and Cost-Sharing Reductions (CSRs). It is designed as a tool to educate navigators, certified application counselors, and other assistors, as well as Marketplace staff, eligibility workers,  and others that need to understand and be able to explain how APTCs and CSRs work in practice. This presentation gives the audience a more visual display to aid in the comprehension of the technical information related to APTCs and CSRs. The document begins with a glossary of key terms and the general role of APTCs and CSRs, and then takes a deeper dive into the technical components. 

On August 15, CMS awarded $67 million in Navigator Cooperative Agreements to 105 entities to serve in the 34 Federally-facilitated and State Partnership Marketplaces. This document lists the recipients of the Navigator grants, grouped by state.

With open enrollment drawing near, exchanges are mobilizing their efforts to provide assistance to individuals who will begin enrolling in coverage options in October. This chart highlights the approaches states have taken to develop education and training for the individuals who will provide enrollment assistance through Navigator and In-Person Assister (IPA) programs. 

This set of instruments released by the Centers for Medicare and Medicaid provides guidance on the methodology and surveys that CMS will use to assess enrollee satisfaction with the Marketplace and QHPs.

This analysis compares the population most likely to enroll in the ACA's nongroup exchanges to those who now have employer coverage, focusing on characteristics related to health risks. If the populations are comparable, unsubsidized premiums in the reformed nongroup market should be set at reasonable levels once reform is fully phased-in. While individuals with higher-than-average health care needs may be somewhat more likely to enroll in the nongroup market in the first year, once past the transition period, the health characteristics of nongroup enrollees can be expected to be quite similar to those with employer-based insurance.

On Friday, July 28, the Centers for Medicare & Medicaid Service (CMS) posted Marketplace Experience and QHP Experience Enrollee Satisfaction Surveys. The survey Paperwork Reduction Act (PRA) packages are available for public comment through August 27.

This rule finalized a slew of regulations related to the structure and operations of Medicaid, CHIP, and exchanges under the ACA. These include eligibility and enrollment requirements for qualified health plans and insurance affordability programs (Medicaid, CHIP, APTCs, and Basic Health Plans). It also detailed minimum standard requirements for Alternative Benefit Plans and changes to eligibility notices and appeals for Medicaid and CHIP. Additionally, it updated the criteria for verification of eligibility and enrollment in employer-sponsored insurance.

This final rule provides standards for federally-funded navigator programs operating in federally facilitated and state partnership exchanges, federally-funded in-person assisters, and certified application counselors (CAC). All exchanges are required to have navigators and CACs, while the requirement to have assisters varies by exchange model. The rule includes standards related to conflict of interest, training and certification, accessibility, and SHOP-only navigators.