5 Things to Know About the Final ACA Marketplace Ruling for 2019

Last week, CMS made their final ruling on the Affordable Care Act (ACA) Marketplace for 2019.

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The ruling is designed to give states more power when it comes to regulating their individual and small-group health insurance markets.

Here are 5 things you should know:

  1. States get to choose their own benefits. CMS is giving each state the ability to choose which services they feel should be essential health benefits. Keep in mind that all states will have to include the 10 essential health benefits already offered by the ACA, such as preventative care and maternity care. But this way states can add additional services that they feel are beneficial to their clients.
  2. Only at a rate increase of 15% or more will a review be done. This increase in the threshold for a review is to help keep costs down for insurers and states. This means if a company plans on increasing their premium rates 15% or more, it will require a review, whereas previously it has been a 10% or more increase. This is due to the fact that the premiums have been increasing a lot in years prior.
  3. There will be less penalties for people who don’t have insurance, or for those who choose to drop it in 2018. CMS is allowing customers the option to drop their health insurance if they are unable to find affordable policies in their area.
  4. Ability to innovate. The final ruling is designed to promote innovation in plan designs by eliminating standardized plans. Standardized plans were designed to make it easier for consumers looking for insurance. But now insurance companies can create plans that they can tailor to specific clients needs.
  5. Changes to the Medical Loss Ratio (MLR) that clients can claim. In 2019 each state can individually request for a lower MLR if it would help to stabilize their market.

All of these changes are huge for the ACA, especially at the state level. How do you feel about these changes?

In our next blog post, we will keep you informed of related issues.  To get this important information delivered directly to your mail box, 

Do you need help staying current and compliant with the latest laws, rules and regulations?  We can help. To contact us about your new government rules and regulations, your practice’s risk assessment, or about your other legal needs:  CLICK HERE.

P.S. If you or your patients are interested in consumer healthcare issues, check out myhealthspin.com.

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