HHS Acts to Protect Health Plans From Risk in Marketplaces


With major health insurers such as UnitedHealthcare, Aetna and Humana pulling out of the Affordable Care Act marketplaces, the Department of Health and Human Services took action to try to protect the remaining health plans from the risk of sicker than expected enrollees.

The agency issued a proposed rule that would make changes to the ACA’s risk adjustment program. Beginning in 2018, prescription drug use data would be included in the calculations to determine the payments insurers that cover sicker enrollees would receive from insurers that cover healthier enrollees.

Beginning in 2017, the risk associated with enrollees who aren’t enrolled for a full 12 months would be reflected. Those enrollees have proved to have higher health costs than people who stay enrolled in a plan for a full year.

“The ACA’s risk adjustment program plays an important role in ensuring that issuers have both the incentives and the financial support to design products to serve all Americans,” Marketplace Chief Executive Officer Kevin Counihan said in a blog posting.

Most health plans offered on the marketplaces have lost money because enrollees are sicker than insurers originally expected and the share of young adults, who are generally healthier than older people and cost less to cover, has not been as high as hoped.

The HHS also is proposing expanding standardized plans that include uniform cost-sharing requirements for consumers, which insurers have the option of offering. Further, a pilot program is being introduced in some states aimed at greater transparency of provider networks in health plans offered through the federal HealthCare.gov marketplace.

About 11.1 million people enrolled in the ACA marketplaces in 2016 and open enrollment for coverage in 2017 is to be held from Nov. 1 through Jan. 31, 2017.

For the entire story, go to http://www.bna.com/changes-health-plan-n73014447000/.

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