CMS Extends SHOP Direct Enrollment Flexibility Until 2018

CMS is allowing State-based SHOPs that do not provide for enrollment through an online portal to continue using "direct enrollment" with insurers through 2018, provided the SHOP already utilizes such an approach. To continue using direct enrollment, a SHOP must submit a plan to CMS describing: how the employer will receive an eligibility determination from the SHOP; how eligible employees and dependents will enroll in a SHOP qualified health plan (QHP); and how the SHOP QHP issuer will conduct enrollment consistent with applicable rules and policies. For 2019 and beyond, State-based SHOPs should have online functionality in place, or they may elect to use the federal platform, utilize a shared or regional SHOP platform, or submit a 1332 waiver to waive online enrollment functionality requirements.

2016 Marketplace Premiums Lower Than Initial Issuer Filings Suggested

The average Marketplace premium increased 8% between 2015 and 2016 despite predictions of double-digit increases that were based on initial issuer rate filings, according to a new report from HHS's Office of the Assistant Secretary for Planning and Evaluation. The report and its accompanying blog post note that those predictions did not take into account public rate review, consumer shopping or premium tax credits, all of which sharply reduce premium costs. The 43% of enrollees who switched plans for 2016 saved an average of $42 per month, and the 85% of enrollees who received tax credits had an average net premium increase of $4 per month. The report comes as issuers begin submitting their initial 2017 qualified health plans rate filings. Some insurers may propose significant rate increases, according to Health Affairs, due to the 2016 expiration of the reinsurance program and insurers' claims that Marketplace enrollees are a higher-cost population than they had anticipated.

UnitedHealthcare to Offer 2017 Marketplace Coverage in "Handful" of States

UnitedHealthcare announced that it will exit all but a "handful" of ACA Marketplaces in 2017, citing high coverage costs and sicker-than-expected enrollees, according to comments made by CEO Stephen Hemsley on a quarterly earnings conference call. Hemsley said the company expects to lose $650 million from its Marketplace business in 2016. The national impact of United's exit on premiums is expected to be minimal, according to a report from the Kaiser Family Foundation released the day before the announcement; however, the report found it will have a significant impact on choice in some locations. According to the authors, United is one of only two insurers offering qualified health plans in 29% of the counties in which it operates.