- CMS finalized a rule lowering the user fee for Affordable Care Act federal exchange plans from 3.5% to 3% and from 3% to 2.5% for state exchange plans. The final Notice of Benefit and Payment Parameters for 2020 also allows insurers to forgo applying drug manufacturer coupons toward patient out-of-pocket cost limits when a brand name drug has a generic alternative available.
- The agency is not taking action now on the practice of silver loading — increasing premiums on the silver tier of health plans to make up for the lost cost-sharing reduction payments (CSRs) — but noted in the rule released Thursday that all commenters supported silver loading as an option for keeping the exchanges affordable for consumers.
- This is the latest a payment rule has been finalized, according to Health Affairs analyst Katie Keith. CMS acknowledged the criticism but is not changing any timelines. Insurers have until June 19 to submit their exchange health plans for 2020.
While the courts proceed to debate the future of the Affordable Care Act, payers will continue to revise and put out new products for the law's exchanges. After a Texas judge declared the landmark law unconstitutional late last year, Democratic attorneys general swiftly appealed. Another hearing on the case is scheduled for July.
The final payment rule issued last week finalizes a change in how the premium adjustment percentage is calculated. That measure is used to set the rate of increase for maximum limits on cost sharing, the required contribution percentage for determining exemptions and employer contribution mandate penalties. Using the new formula, the premium adjustment percentage for 2020 is about 1.29%, CMS said.
The Center on Budget and Policy Priorities said the change will raise premiums for more than 7 million people in the marketplace and increase limits on out-of-pocket costs for millions, including those who get coverage through their employer. "Families that experience costly illnesses or injuries, whether insured through the marketplace or through their employer, could face an additional $400 in medical bills because of the new policy," according to the analysis. "People with pre-existing health conditions, who are more likely to reach their plans’ limits on total out-of-pocket costs, will be disproportionately affected."
As for silver loading, CMS said it still supports a law to appropriate CSRs and end the practice, but in the meantime will take the comments "into consideration in determining whether future action is appropriate."