HHS wants to help consumers re-enroll in lower-cost ACA plans

Feds also want to shorten the 2016 open enrollment period

HHS on Friday released a proposed rule that would provide consumers with a menu of automatic enrollment options when they first sign up for coverage offered through HealthCare.gov.

CMS in September released final regulations stating that the federal exchange will automatically renew health plans for 2015 if consumers have not taken action by Dec. 15. Meanwhile, states that run their own insurance exchanges can create their own re-enrollment initiatives.

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On Friday, HHS said it is considering allowing consumers to select from a menu of auto-enrollment options when they first sign-up for coverage. Under the proposal, after their first year of coverage, consumers could choose to be automatically enrolled:

  • In their same plan, regardless of premium changes;
  • In the least-costly plan with comparable benefits; or
  • In one of the three least-costly plans with comparable benefits if their current plan's premium increases by a certain amount.

Under the proposal, state-based exchanges could decide whether to offer the new auto-enrollment options in 2016. In addition, the federal exchange would implement the auto-enrollment choices for consumers in 2017.

HHS said, "Default enrollment in the same or similar plan may sometimes encourage consumers to remain in plans that are significantly more expensive than the lowest-cost plans in the market. Because we believe that many consumers place a high value on low premiums when selecting a plan, we believe that consumers could benefit from alternative re-enrollment hierarchies."

In the draft rule, HHS also proposed:

  • Creating a standard timeline for small-group and individual market plans for reporting rate increase requests;
  • Extending mandatory rate review to exchange plans that propose increasing premiums by 10% or more;
  • Changing the dates of the next open enrollment period to Oct. 1, 2015, through Dec. 15, 2015;
  • Lowering the threshold at which CMS would pay insurers half the cost of high-cost cases from $70,000 in 2015 to $45,000 in 2016 in some instances;
  • Providing additional details and regulations for the process of requesting that insurers cover medications that were not originally in the health plan's formulary;
  • Requiring exchange plans to update their provider directories on at least a monthly basis and list more detailed provider information, including whether providers are taking new patients;
  • Require insurers to pay an annual $27 tax per enrollee and a user fee amounting to 3.5% of premiums in 2016; and
  • Require insurers to provide new enrollees with a 30-day transition period to change physicians prior to a physician being considered out-of-network.

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In addition, HHS said it is considering requiring insurers to make provider directories available on their websites via a "machine-readable file."

HHS is seeking comments on the proposed rules through Dec. 26 (Sanger-Katz, "The Upshot," New York Times, 11/21; Baker, National Journal, 11/21; Herman/Demko, Modern Healthcare, 11/21 [subscription required]; Adams, CQ HealthBeat, 11/21 [subscription required]).

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