May 19 – June 1, 2015

Enrollment Update for the Federally Facilitated MarketplaceNearly 150,000 Americans living in federally facilitated marketplace (FFM) states enrolled in health coverage during a March 15 – April 30 Special Enrollment Period (SEP) that was made available to uninsured consumers who faced a tax penalty for not having coverage in 2014. These consumers will not face a penalty on their 2015 tax return as long as they maintain their coverage throughout the year.

More Than 70 Percent of Marketplace Enrollees Rate Their Coverage as “Excellent” or “Good”: A new survey from the Kaiser Family Foundation, released on May 21, examines attitudes and experiences of people enrolled in health coverage on the individual market — including the marketplaces. The survey found that more than 70 percent of people enrolled in coverage through the marketplaces rated their coverage as “excellent” or “good,” and 75 percent were “very” or “somewhat” satisfied with the hospitals and primary care providers in their networks.

Updates to the FFM Streamlined Application: The FFM updated its streamlined application to make it easier for consumers to understand which questions they need to answer about the whole household, which questions just apply to applicants looking for coverage, and which questions are about individual applicants. The changes are summarized in this slide presentation from a May 21 webinar for assisters.

Centers for Medicare and Medicaid Services Provides Information and Requests Comments on an Out-of-Pocket Cost Calculator: On May 29, the Centers for Medicare and Medicaid Services (CMS) posted a bulletin with details on a forthcoming out-of-pocket cost comparison tool for the FFM. CMS is requesting comments on methodology for the tool, how it could be incorporated on FFM websites, and whether the code should be made available to state-based marketplaces (SBMs). Comments are due June 29.

Insurers Submit Proposed Rates for the 2016 Plan Year: To prepare for the third open enrollment period (OE3), insurers are submitting proposed health insurance rates for the 2016 plan year to state insurance departments, as well as the FFM and SBMs. On June 1, as part of the state and federal rate review process, CMS posted proposed rate increases of 10 percent or higher for all FFM states and some SBM states (some states also included proposed rates below 10 percent) to a searchable online directory:  In addition to this transparency requirement, insurers must justify rate increases of 10 percent or higher, and regulators and consumers have a chance to comment on the insurers’ cost assumptions as part of the rate review process. Final rates will be released by November 1, when OE3 begins.

FFM Assister Training for 2015 Available Until June 15: On June 15, the FFM’s online training for assisters will no longer be available for the 2015 plan year. The last day for Navigators, Certified Application Counselors, and other in-person assisters to sign up to access the training was June 1.

New Medicaid Managed Care Regulations Released: On May 26, CMS proposed new managed care regulations for Medicaid and the Children’s Health Insurance Program (CHIP). The managed care rules have not been updated in more than a decade, and touch on a wide range of issues including consumer experience in enrollment, delivery system reform, and quality of care. Comments on the proposed rules are due July 27.

State Updates:

  • California: On May 21, the Covered California board of directors voted to cap costs of specialty prescription drugs for consumers enrolled in 2016 marketplace plans. The caps range from $150 to $500 a month for enrollees depending on the plan tier.
  • Connecticut: To help achieve financial sustainability, the Access Health Connecticut board of directors voted to collect 1.65 percent of premiums for each 2016 marketplace plan (up from 1.35 in 2015).
  • Pennsylvania: On June 2, the Pennsylvania Department of Insurance submitted an application to set up an SBM as part of the governor’s contingency plan for a King v. Burwell Supreme Court decision where consumers would no longer be able to receive financial assistance to purchase coverage in FFM states.
  • Vermont: Between May 28 and June 1, the Vermont Health Connect enrollment platform was taken offline for a systems update that will make it easier for consumers to report life changes that could qualify them for new coverage options.
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