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Life Health > Health Insurance

CMS questions use of PPACA exchange option

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Officials at the Centers for Medicare & Medicaid Services are trying to get state regulators to think carefully before letting their state exchanges sell “employee choice” programs.

Officials say adding choice programs could lead to higher prices.

CMS officials bring up the issue in a choice program recommendation form for insurance commissioners in the states with HHS-run exchanges.

An employee in a choice program can choose from a menu of several different coverage choices.

In instructions, CMS officials say: “Please adequately explain that it is in your expert judgment, based on a documented assessment of the full landscape of the small group market in your state that the 2015 Transition to Employee Choice would be in the best interest of small employers and their employees and dependents, given the likelihood that implementing employee choice would cause issuers to price their products and plans higher than they would otherwise price them.”

“Please base your recommendation on discussions with those issuers expected to participate in the SHOP, including naming those issuers,” officials say.

The Federal Employees’ Health Benefit Plan, many state public employee health plans, and some single-state health insurance purchasing arrangements have offered employee choice arrangements for years.

Under the Patient Protection and Affordable Care Act, a provision requires state Small Business Health Options Program exchange divisions to offer small employers choice programs.

A SHOP choice program is supposed to let an employer’s employees choose from a menu that includes all plans available at a given metal level. A SHOP choice program could offer employees access to all bronze plans, all silver plans, all gold plans or all platinum plans.

PPACA called for SHOP exchange divisions to start offering choice programs this year. 

In June 2013, HHS let state-based exchanges choose between offering choice programs this year or waiting until 2015.

HHS postponed the start of choice programs in the HHS-run exchanges until 2015.

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