Source: Healthcare Dive
Dive Brief:
- The Biden administration on Monday finalized a rule making it easier for regulators to punish insurance agents and brokers for violating rules when selling Affordable Care Act plans.
- The rule expands the CMS’ ability to immediately suspend a broker from the marketplace if they pose a risk to eligibility determinations, operations or enrollees. It also updates consent forms to ensure applications for plans are accurate and to prevent unauthorized changes to ACA coverage, according to regulators.
- The rule also notifies consumers who have failed to reconcile government subsidies for ACA plans in annual income tax filings that they’re at risk of losing the financial assistance, and makes it harder for insurers to disenroll consumers who struggle to pay premiums.
Dive Insight:
The goal of the final rule is to increase trust in the ACA exchanges and make it easier for consumers to enroll in coverage for next year, according to the CMS.
Changes to consent forms, for example, should lower the risk of financial errors like consumers incorrectly receiving an advance on subsidies or people being enrolled in coverage without their say-so.
Intermediaries that help people choose between ACA coverage have come under increased criticism for switching people’s plans without their consent to gain commissions. That can leave consumers unable to access medical services and on the hook for additional out-of-pocket costs — or potentially steep back taxes, if they were signed up for subsidized coverage they’re not actually eligible for.
Monday’s final rule also solidifies provisions under which insurers can terminate coverage for members unable to pay premiums. Now, payers can use one of two premium thresholds: a fixed-dollar threshold of $10, or a percentage-based threshold of 95% of net premiums (after financial subsidies are applied) or 98% of gross premiums. Consumers who owe below those thresholds can’t be disenrolled from coverage.
The rule comes six days before the swearing in of President-elect Donald Trump, and as such is likely one of the last, if not the last, word from the Biden administration on the ACA. Bolstering the exchanges set up by the 15-year-old law has been the linchpin of the Biden administration’s health policy agenda, with regulators working to crack down on unethical broker practices and enact more generous federal subsidies so that more Americans can afford plans.
Some uncertainty is on the horizon for people in the exchanges, as Trump has made no secret of his antipathy toward the law. Similarly, it’s an open question whether Republicans in Congress will allow the expanded tax credits, which are projected to cost taxpayers about $335 billion over the next decade, to continue beyond 2025.
So far, almost 24 million people have signed up for ACA plans for 2025, according to the CMS.
Open enrollment closes Wednesday.
