The Department of Health and Human Services amended a few Affordable Care Act rules in an effort to stabilize the current marketplace.
Among the major changes is a shrinking of the annual open enrollment period and more strict requirements surrounding special enrollment periods.
The annual open enrollment period for 2018 will begin earlier, opening November 1 and closing December 15, 2017. The new open enrollment cuts last year’s three-month period in half.
Individuals attempting to use a special enrollment period to enroll outside of open enrollment must submit supporting documentation to ensure only those eligible to enroll can do so.
Guaranteed Availability of Coverage
Individuals must pay back past-due premiums before enrolling into a plan with the same issuer the following year.
HHS believes the rule will improve the risk pool by “removing economic incentives individuals may have had to pay premiums only when they were in need of healthcare services, particularly toward the end of the benefit year.” It should also encourage continuous coverage through the year.
Levels of Coverage
Beginning with 2018 plans, insurers now have more actuarial flexibility to create more choices with lower premium options for consumers.
The federal government will no longer review network adequacy, returning oversight to the states.
Qualified Health Plans must maintain a network that is sufficient in number and types of providers, including providers that specialize in mental health and substance abuse services. HHS will defer to state or HHS-recognized independent accrediting entities for verification of these reviews.
The new rules will take effect June 19 of this year.