Insurance Exchanges

The U.S. Office of Personnel Management (OPM) issued a proposed rule to implement modifications to the Multi-State Plan (MSP) Program based on the experience of the program to date. This proposed rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers that contract with OPM to offer MSP options. This proposed rule amends MSP standards related to coverage area, benefits, and certain contracting provisions under section 1334 of the Affordable Care Act. This document also makes non-substantive technical changes.
 

The end of the ACA’s first open enrollment period has seen better-than-expected participation and a significant drop in the number of uninsured, particularly in states that expanded Medicaid. However, many eligible uninsured have not yet signed up. This paper focuses on one factor that has emerged as a challenge to marketplace enrollment: namely, consumers’ perception that, even with federal subsidies, Qualified Health Plans are not affordable. The paper begins by analyzing how this factor played out during the open enrollment season for 2014, and then describes promising practices implemented by particular states to improve the affordability of coverage.
 

To achieve enrollment targets for 2015, the health insurance marketplaces must rely on millions of consumers renewing their current marketplace health plans. This is no small effort, and the marketplaces are constrained by information technology capacity, a short enrollment time frame, and limited resources for outreach and consumer assistance. This report examines the efforts of six state-based marketplaces (California, Colorado, Kentucky, Maryland, Rhode Island and Washington) to successfully renew health coverage for millions of marketplace enrollees.
 

All qualified health plans under the ACA must cover a package of essential health benefits (EHBs) equal in scope to a typical employer plan. The law laid out 10 general categories of services that EHBs must cover, but did not itemize those services. As an interim policy for 2014 and 2015, the Department of Health and Human Services allowed each state to identify an existing plan as a benchmark for these EHBs. The result of this policy is that EHBs vary from state to state, often because of a legacy of different state-mandated benefits (such as treatments for autism, infertility, or temporomandibular joint disorders). This brief analyzes state variation in coverage and limits for these non-uniform benefits.
 

This new report captures insights from those who helped consumers navigate the ACA’s first open enrollment period, including lessons for the second, which is set to start Nov. 15. The report draws on the experiences of 80 program leaders who participated in a roundtable discussion convened by the foundations in June. The group talked about consumer education and engagement, options for improving consumer notices and technical support for assisters, ways to better help people make informed choices, and the need to continue assisting consumers after enrollment.
 

To help enrollees new to the system keep their insurance, the ACA provides a ninety-day grace period before an insurer can discontinue someone's coverage for failure to pay a monthly premium. This applies only to those who have received an advance premium tax credit to purchase health insurance through the Marketplaces and have previously paid at least one month's full premium in that benefit year. This Health Policy Brief focuses on CMS's implementation of the ACA grace period and concerns from hospitals and physicians about potential financial liability now that millions of people have signed up for subsidized health insurance on the Marketplace exchanges.
 

By the end of the first open enrollment period for coverage offered through the ACA’s marketplaces, increasing numbers of people said they found it easy to find a plan they could afford, according to The Commonwealth Fund’s Affordable Care Act Tracking Survey, April–June 2014. Adults with low or moderate incomes were more likely to say it was easy to find an affordable plan than were adults with higher incomes. Adults with low or moderate incomes who purchased a plan through the marketplaces this year have similar premium costs and deductibles as adults in the same income ranges with employer-provided coverage. A majority of adults with marketplace coverage gave high ratings to their insurance and were confident in their ability to afford the care they need when sick.

This final rule specifies additional options for annual eligibility redeterminations, as well as renewal and re-enrollment notice requirements for qualified health plans offered through the Marketplace, beginning with annual redeterminations for coverage for benefit year 2015. This final rule provides additional flexibility for Marketplaces, including the ability to propose unique approaches that meet specific needs of their state, while streamlining the consumer experience.
 

Going into the second open enrollment period for the health insurance marketplaces, the enrollment community must focus on both getting more uninsured consumers enrolled and also ensuring that those who are already enrolled retain coverage. It is crucial that the enrollment community organize around simple, unified messages for consumers, including those enrolling for the first time and those who are renewing coverage. This memo presents Enroll America’s suggestions for a simple consumer messaging framework in the months leading up to and during the second open enrollment period.
 

Under the ACA, the health insurance marketplaces can encourage improvements in health care quality by: allowing consumers to compare plans based on quality and value, setting common quality improvement requirements for qualified health plans, and collecting quality and cost data to inform improvements. This issue brief reviews actions taken by state-based marketplaces to improve health care quality in three areas: 1) using selective contracting to drive quality and delivery system reforms; 2) informing consumers about plan quality; and 3) collecting data to inform quality improvement.