CMS Encourages Innovation!

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On Monday April 9, 2018 the Centers for Medicare and Medicaid finalized the rule that “eliminates (Affordable Care Act) standardized options starting in 2019 to encourage innovative plan designs among insurers.”

This is a good move for the coming years in the, non-Medicare, individual/family health insurance markets of America!  This change indicates that our current government recognizes that health insurance plans are not a one-size-fits-all financial product.  We have been saying this all along and CMS Director Verma has now been quoted saying as much- and we are thankful.

At this time it is unclear if ACA-compliant plans this fall, for the 2019 calendar year, will reflect this change in standardization requirements, and make health insurance plans more reflective of the coverage needs of the people in each state.  However, since the standardization requirements are eliminated in 2019- we do expect the individual/family plans, for the 2020 calendar year, to be more fitted to each state.

As everyone anticipates smart changes coming in the years ahead to the individual/family health insurance market we should be aware that according to Director Verma, the states are still subject to the ACA requirement that insurers offer 10 essential health benefits.  Although the standardization requirements are eliminated, this doesn’t mean states can allow ACA-compliant plans to exclude maternity care or mental health benefits.

We do expect to have more appropriate premiums and coverage choices for individuals and families in the coming years.  All in all, a good day.

Reference: Shelby Livingston and Susannah Luthi, Modern Healthcare.

Teresa
Teresa

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