If enrollees in PPACA plans don't change their plans during next year's enrollment season and find cheaper coverage, then federal health officials might do it for them.
That's one big takeaway from a 324-page regulation released by the Centers for Medicare and Medicaid Services late Friday regarding how the exchanges will work in 2016. Other big changes proposed include a shorter open enrollment season and more transparency among carriers, as well as a slew of reminders and clarifications for carriers.
CMS said it was considering automatically enrolling consumers into other plans simply because consumers often favor cheaper plans, though don't often make that change themselves.
Recommended For You
"This alternative enrollment hierarchy could be triggered if the enrollee's current plan's premium increased from the prior year, or increased relative to the premium of other similar plans by more than a threshold amount," the regulation read. "As is the case under the existing approach, a consumer would retain the option to take action to enroll in a different plan during open enrollment if he or she wished to do so."
The considered rules wouldn't apply until the 2016 benefit year, if approved.
In analysis last week, consulting firm Avalere Health said the most popular PPACA plans are increasing by an average of 10 percent this enrollment season. At the same time, the firm warned that those who choose to automatically be enrolled in their previous plans without shopping around could face even higher increases, while underscoring the importance of shopping around.
The administration announced this summer PPACA's new auto-enrollment feature. Avalere researchers said they expect most consumers to simply let their plans auto-renew, though it will hurt their wallets.
On Dec. 15, consumers who are already insured through PPACA's exchanges will automatically be enrolled again in their current plan.
In a press release, CMS said PPACA's new slew of proposed rules would "further strengthen transparency, accountability, and the availability of information for consumers about their health plans."
"It is one of our many goals to strengthen the integrity of programs that fall under the Affordable Care Act to ensure the delivery of quality care with affordable options," said CMS Administrator Marilyn Tavenner. "CMS is working to improve the consumer experience and promote accountability, uniformity and transparency in private health insurance."
Other proposed rules for 2016 enrollment include:
- Open enrollment for 2016, and beyond, would run Oct. 1, 2015, through Dec. 15. That would mean a sign-up season two weeks shorter than the current season.
- States would select new benchmark plans for 2017, based on plans available in 2014.
- A health plan must publish an up-to-date, accurate, and complete list of all covered drugs on its formulary drug list, including any tiering structure and any restrictions on the manner in which a drug can be obtained.
- The rule proposes to streamline the administration of group coverage provided through Small Business Health Options Program and to align SHOP regulations with existing market practices.
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
