June 26, 2014
HHS announces auto-enrollment plans for current Marketplace consumers for 2015
Today, the U.S. Department of Health and Human Services (HHS) expects to announce its plans for helping existing Marketplace consumers get auto-enrolled for next year. These plans would give existing consumers a simple way to remain in the same plan next year unless they want to shop for another plan and choose to make changes.
“As we plan for open enrollment in year two and continue to build a sustainable long-term system, we are committed to simplifying the experience for consumers by allowing auto-enrollment,” said Sylvia Mathews Burwell, Secretary of HHS. “We are working to streamline the process for consumers wishing to remain in their current plan.”
In today’s health insurance market, the vast majority of consumers are generally auto-enrolled in their plan year after year. For example, about 88 percent of employees receiving coverage through the Federal Employee Health Benefits Program don’t choose to change plans and are instead auto-enrolled in their current plan with updated premiums and benefits. These guidelines aim to bring the Marketplace in line with this practice in the existing insurance market.
As with existing open enrollment periods for employer-based coverage, consumers are strongly encouraged to use the open enrollment period as an opportunity to update their information and reevaluate their health coverage needs for the coming year.
Consumers always have the ability to return to the system for shopping, changing plans, or reporting life changes, or a change to their annual income to ensure they are getting the lowest cost possible on their monthly premium. And, to help ensure the program integrity of how taxpayer dollars are spent, while also protecting consumers from having to pay back tax credits they are no longer eligible for, under the approach that the Federally-facilitated Marketplace would use in 2015, the small number of consumers whose updated income information suggests they no longer qualify for a tax credit next year, will still be auto-enrolled in their current plan, but without a tax credit. State-based Marketplaces may take this approach as well, or propose an alternative.
Under the plans that HHS expects to announce today, consumers in the Federally-facilitated Marketplace will receive notices from the Marketplace informing them how to update their information to get a tailored and updated tax credit that keeps up with any income changes. Consumers will receive information from their health insurance company about the premium and the amount they are eligible to save on their monthly bill close to the beginning of the open enrollment period, when they will be able to take action should they choose to do so.
“We are continuing to plan for a second open enrollment period, and as we do so, are mindful of our ongoing work to improve the Marketplace for consumers, offering families a way to make the choices that meet their health care needs year after year,” said Marilyn Tavenner, Administrator of the Centers for Medicare & Medicaid Services (CMS).
We are also announcing plans for additional flexibility for State-based Marketplaces in this area, including the ability for State-based Marketplaces to propose unique approaches that meet the specific needs of their State, while streamlining the consumer experience.
To read today’s proposed rule visit: http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/508_CMS-9941-P-OFRv-6-26-14.pdf
To read today’s Guidance on Annual Redeterminations for 2015 visit: http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/2014-0626-Guidance-on-annual-redet-option-2015-FINAL.pdf
The draft issuer renewal and discontinuance notices are open to public comment and may be viewed here: http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/2014-0626-Bulletin-on-Renewal-and-Termination-Notices-FINAL.pdf
Instructions are available here: http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/0626-2014-Notice-instructions.pdf