ACA Exchanges

Biden Admin Aims to Stymie MLR Inflation Among ACA Plans

In its annual omnibus regulation for the Affordable Care Act exchanges, CMS revealed that it aims to crack down on some questionable behavior used by health plans when calculating their medical loss ratios (MLRs) — a move that will likely result in insurers paying even higher rebate amounts to consumers than they already are.

The ACA requires individual and small-group market insurers to spend at least 80% of their premium income on medical care and quality improvement. For the large-group market, that threshold is 85%. If insurers’ MLRs dip below those percentages, they’re required to return the difference to plan members. MLR rebates, which are calculated using a three-year average, have risen considerably in recent years and totaled $2 billion for the 2020 plan year.

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News Briefs: HHS Renews Public Health Emergency | Jan. 21, 2022

HHS Sec. Xavier Becerra renewed the COVID-19 pandemic public health emergency until April 16, extending the PHE that was first announced on Jan. 31, 2020, by then-HHS Sec. Alex Azar into its third year. The PHE declaration makes possible enhanced Medicaid funding — in exchange for states pausing eligibility redeterminations — and expanded telehealth flexibilities for Medicare and Medicaid beneficiaries.

New insurer entry into the Affordable Care Act (ACA) exchanges is slowing down after several boom years, according to a new Robert Wood Johnson Foundation report. “While the total number of plan offerings increased by about one third between 2020 and 2021 (from 10,289 to 13,596), this year’s increase to 15,638 constitutes growth of about 15 percent,” wrote Katherine Hempstead, Ph.D., senior policy adviser for the foundation.

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News Briefs: More than 14M Sign Up for ACA Plans | Jan. 14, 2022

With the annual open enrollment period for Affordable Care Act marketplace plans about to close, HHS reports that more than 14.2 million people have signed up for plans since the OEP started on Nov. 1, 2021. That figure includes 10 million people selecting or being automatically enrolled in plans on HealthCare.gov through Jan. 12 and 4.2 million on the state-based marketplaces as of Jan. 8. The federal OEP for 2022 plans ends Jan. 15 — making it a month longer than signup periods during the Trump administration. HHS also released a report that detailed how the expansion of premium subsidies under the American Rescue Plan Act has led more customers to choose plans with lower deductibles.

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2022 Outlook: Experts See Favorable Milieu for Payers, but Uncertainties Loom

The federal government may be spurred to action on several fronts, from seeking to maintain elevated health insurance exchange subsidies to further extensions of the COVID-19 public health emergency (PHE), which would have beneficial short- and long-term financial implications for health insurers in 2022.

Those are just two areas that, pending federal action, could deliver significant wins for health plans this year, according to a panel of experts from Avalere Health during the Jan. 6 webinar, Avalere 2022 Healthcare Industry Outlook: Advance Your Opportunity.

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2022 Outlook: This Year, ‘Smooth Sailing’ Appears Likely for ACA Exchanges

For health insurers that operate in the Affordable Care Act exchanges, 2022 is shaping up to be a relatively stable, profitable year with few regulatory surprises, health policy experts tell AIS Health. Still, there will be some regulatory uncertainty that plans must grapple with as well as a newly proposed rule effective in 2023 that imposes tighter controls on benefits and network design than even the Obama administration attempted.

That regulation is the Notice of Benefit and Payment Parameters (NBPP) 2023 Proposed Rule, released by the Biden administration on Dec. 28. Perhaps the biggest change included in the annual omnibus exchange rule — the move to require standardized ACA marketplace plans — was already known to the industry but still promises to make a significant impact.

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By the Numbers: National Health Insurance Market in December 2021

Although the pandemic-driven economic crisis led to a massive increase in unemployment, loss of commercial health coverage has not been as great as predicted, and enrollment has rebounded over the past year. Meanwhile, the launch of a special enrollment period for the federal health insurance exchange and the temporarily expanded premium subsidies in the individual market led to membership growth in managed Medicaid and exchange plans, according to AIS’s Directory of Health Plans. Among the top five Blue Cross Blue Shield plans, all but BCBS of Illinois saw enrollment increases compared with December 2020.

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Big MLR Rebates Point to Ever-More-Profitable ACA Exchanges

Recently, CMS revealed that private health plans had to deliver $2 billion in rebates to their customers for the 2020 reporting year, with the bulk of that money going toward individual market enrollees. Affordable Care Act experts say that while the large rebate payout does mean premiums have been overpriced, it’s also indicative of just how profitable the ACA exchanges have become for insurers.

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Biden Admin Touts Record Marketplace Open Enrollment

Sign-ups for health plans on the individual exchanges have hit a record high six weeks into open enrollment, according to CMS: 13.6 million people have enrolled in coverage for 2022, with a month still left to go in the annual open enrollment period. That includes 9.7 million who have enrolled in HealthCare.gov plans, which is the federal platform used by 33 states, and 3.9 million who have enrolled via the 18 state-based marketplaces.

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News Briefs: Centene CEO Neidorff to Retire | Dec. 17, 2021

Centene Corp. Chairman and CEO Michael Neidorff plans to retire in 2022 from his role as chief executive, although he will serve as executive chairman of the insurer’s board of directors until the end of next year. Centene’s board “will be responsible for appointing a new CEO following a thorough selection process, including evaluating internal and external candidates with the support of an external search firm,” the company said on Dec. 14. In September, Centene promoted Sarah London to the role of vice chairman for its board of directors, and some industry analysts speculated that could put her in a position to succeed Neidorff, who has been Centene’s CEO since 1996.

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Average ACA Benchmark Premium Drops for Fourth Year in a Row

Average premiums for the Affordable Care Act Marketplace benchmark silver plan fell 3.1% across the country in 2022, although the changes varied by location and type of plan, according to a Kaiser Family Foundation county-level analysis. Because the American Rescue Plan Act temporarily increased and expanded subsidies for low- and middle-income individuals and families, tax credits will cover the full premium for the lowest-cost silver plan for a 40-year-old individual earning $20,000 (155% of the federal poverty level) in two-thirds of counties nationwide. The ACA open enrollment period for HealthCare.gov and most state-based marketplaces began Nov. 1 and ends on Jan. 15.

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