On December 16th 2016, The Centers for Medicare & Medicaid Services (CMS) finalized the Benefit and Payment Parameters rule for 2018, which will continue to strengthen the Health Insurance Marketplace that millions of Americans rely on for health coverage. The main reason of the notice is risk stabilization. This will improve the risk pool, including actions to address third party payments of premiums as well as improve program integrity for special enrollment periods.
“The improvements announced today build upon years of work to implement a Marketplace that is capable of providing high quality, affordable coverage to all Americans no matter their health status, their income, or where they live” said CMS Acting Administrator Andy Slavitt. “The Administration will leave the Marketplace on a stable path that, when fully implemented, will ensure quality coverage is available for all Americans well into the future.”
The Centers for Medicare & Medicaid Services (CMS) has taken a few years to improve and continue to steady the marketplace by listening to important stakeholders.
In the most recent announcement, The Centers for Medicare & Medicaid Services (CMS) is creating a next generation risk adjustment model that addresses four specific phenomena. The new risk adjustment model will: (1) account for the number of individuals who had a Marketplace plan for less than 12 months; (2) better account for the risk of high-cost patients; (3) improves compensation for healthier members; and (4) use prescription drug data as another way to account for sicker members.
The final benefit rule also contains other necessities to progress the Marketplace experience and strengthen the individual and small group markets as a whole. This will give additional tools in order to assess and compare plan networks as well as broaden availability of this years plan options and create consumer protections for new enrollees who are enrolling through the channel.