President Donald Trump’s administration has formally adopted regulations that could help increase the stability of the individual major medical insurance market, and the Affordable Care Act exchange system, in 2018.
One big change in the new package of regulations will move the end of the open enrollment period for 2018 individual major medical coverage to Dec. 15, from Jan. 31, 2018.
(Related: 5 Agent Jabs at a Draft ACA Date Change)
The Centers for Medicare & Medicaid Services (CMS), the agency that put out the packet of regulations, also has made a final decision to:
Require all consumers who apply for “special enrollment periods,” or exceptions to the usual individual major medical open enrollment period deadline, through HealthCare.gov to provide documents showing they qualify for SEPs before they get health coverage in place.
Let states that have shown they take evaluating health provider networks seriously continue to set provider network adequacy standards for the exchange plans in their states.
Give exchange plan issuers a little more wiggle room when it comes to meeting ACA health plan actuarial value standards.
CMS began formal work on the new regulations after Trump took the oath of office, but they appear to reflect changes that CMS officials began to develop while Barack Obama was still president.
CMS assumes in the regulations that existing laws, regulations and batches of informal guidance related to the ACA exchange system and ACA individual major medical rules will stay in place.
The ACA has blocked health insurers from considering personal health factors other than age and location when issuing coverage, pricing coverage or designing benefits since Jan. 1, 2014.
Regulators, insurers and ACA exchange plan managers developed the open enrollment period calendar, or limits on when people can buy individual health coverage without showing they have what the government classifies as a good reason to do so, to discourage healthy people from waiting until they get sick to pay for coverage.