Insurance experts watching for new rules
"The prognosis is that the (Affordable Care Act) market is not collapsing, but it's not a bed of roses," said
The people eligible for subsidies will continue to be insulated from premium increases, but those who make too much to qualify will continue to have a hard time finding affordable individual policies on or off the market.
"It's rendering major medical unaffordable for most people," shopping on the individual plan market, Corlette said.
Mississippi Insurance Commissioner
"The big concern with association health insurance is will insurance commissioners return authority over their plans," said
Wider use of short-term plans could be a benefit for those who are between jobs and can't afford a COBRA to continue their old insurance, Chaney said. The plans are currently limited to 90 days; proposed rules are considering allowing them to be extended for year.
"That could be a real benefit," Chaney said.
Unlike ACA-compliant plans, the short term plans are able to exclude those with pre-existing conditions.
The insurance department is also exploring options that might allow pathways for low-income Mississippians to access some health care coverage, Chaney said.
"We're looking for flexibility on non-ACA compliant policies," Chaney said.
ACA payment rule
During the
The proposed rule would give states a lot of flexibility in determining the essential health benefits, both in terms of the broad categories and then defining what is covered within those categories, Fiedler said. Right now, the
"It would likely prevent the elimination (of an entire category of health benefit) but it it gives them room to significantly narrow it," Fiedler said.
"If even one state decides to narrow (essential health benefits) you could see changes in large plans nationwide," Fiedler said.
Depending on how HHS intends to set the regulations and enforce them, insurers could use the substantially equal provisions to offer more outpatient services and fewer inpatient services, Fiedler said. It could result in shifting costs to sicker patients.
In
The proposed rules would further reduce the navigator program, which provided trained, in-person sign-up support, Corlette said. Current rules require navigator grants go to at least two organizations in each state, one of which had to be a community-based organization.
The proposed rule also would decrease direct enrollment where consumers bypass the healthcare.gov website to enroll through in-person and online brokers.
"There's an increasing sense that HHS wants direct enrollment to become a much bigger pathway," Corlette said. That could be positive, allowing more avenues to enroll and incentives for brokers. It could be troublesome if there's consumer confusion over ACA-compliant plans and non-compliant short term plans.
There is some question about if the proposed payment rule will go into effect for next year, Corlette said. During the public comment period, some insurers have said the proposed changes are so sweeping, it would be impossible to implement in 2019, especially since the final rule is about a month behind when the final rules have been published previously.
Rate forecast
Based on current conditions, Chaney anticipates that rates for group health insurance will remain level or even decline. He expects individual plans not on the exchange could increase by 10 to 12 percent.
Ambetter by Magnolia has indicated it plans to remain on the federal health insurance exchange in all 82 counties in
"My educated guess is that rates will not go up more than 4 or 5 percent," Chaney said.
Instead of loading price increases onto silver level plans on the exchange, which are used to set subsidies, Chaney has opted not to have any increases because of the loss of cost-sharing reduction payments spread across all exchange plans.
"If we spread it, the tax credit is more equalized for all consumers," Chaney said. "We're trying to be fair to everybody."
Some states have allowed the increases to be loaded onto the silver tier, which can stretch the subsidies farther for bronze level plans. However, it can significantly increase costs for consumers that need silver level plans and don't qualify for subsides.
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