Obamacare Enrollees in Less Danger of Losing Subsidies Under Rule

Consumers who allow their Obamacare plans to be automatically re-enrolled in 2021 won’t face the loss of subsidies under a final rule released Thursday by the Department of Health and Human Services.

The final 2021 Notice of Benefit and Payment Parameters rule didn’t change procedures for automatic re-enrollment in Affordable Care Act plans even though the Centers for Medicare & Medicaid Services had asked for comments on potential changes. Most commenters opposed them.

The Trump administration has already made many substantive changes to the ACA, such as allowing plans that don’t comply with its requirements to be in effect for up to three years instead of the three-month limit imposed by the Obama administration. The payment rule released May 7 makes more minor changes.

Rule Is Late

The CMS had asked for comments on denying ACA premium subsidies to people who automatically re-enroll in plans that result in them not having to pay any premiums. Automatic re-enrollment could result in federal payments for which consumers are not eligible, the CMS said.

About 1.8 million people automatically re-enrolled in plans for the 2019 plan year, including about 270,000 people who paid no premiums once subsidies were allocated, the CMS said in the rule.

But most commenters supported the current automatic re-enrollment process, citing benefits such as getting more healthy consumers, who would be less likely to go through the enrollment process if they weren’t able to automatically renew, the CMS said.

The rule for Obamacare exchanges is normally finalized each year well before plans are required to file their rates for the following year. This year, plans already filed their rates in the District of Columbia, and the city’s Department of Insurance, Securities and Banking is expected to release the rate proposals the week of May 11, associate insurance commissioner Philip Barlow said in an email.

The CMS said it has put in place other procedures if consumers’ tax filings don’t match other available income information. ACA premium subsidies are based on household income.

Quicker Coverage for Life Changes

Consumers who have major life changes, such as losing employer coverage due to job loss, can get ACA coverage sooner starting in January 2022 under changes made in the rule. Many health-care advocates have called for the administration to allow people to sign up for coverage in the federal exchange given that more than 30 million people are unemployed due to the coronavirus pandemic.

So far, the administration has declined to do so, saying people can use special enrollment periods available when losing coverage due to a job loss.

The rule allows health plans to offer services like blood pressure monitoring or cardiac rehabilitation without requiring consumers to make out-of-pocket payments. That is intended to allow consumers to receive some services without having to meet the high deductibles required by many ACA plans. Deductibles are the annual amount of medical bills people must pay before a health plan pays any claims.

The average unsubsidized deductible for ACA plans offered through HealthCare.gov increased 4% in 2020 to $5,316 a year, the Department of Health and Human Services reported April 1.

The rule also makes changes intended to ensure that the government pays the correct amount of premium subsidies by checking data to detect enrollees who have died or who are enrolled in Medicare.

States will have to provide more information about benefits they require of health plans. Under the ACA, states must pay for any benefits that exceed ACA benefits.

In a move unpopular with some patient advocate groups, the rule also said health insurers don’t have to count copayments from drug manufacturers as part of patient out-of-pocket cost-sharing responsibilities. That means patients will have to make those payments before insurers must pay their claims.

In 2018 drug manufacturers provided assistance with patient copayments totaling $13 billion, according to the HIV+Hepatitis Policy Institute, which supports allowing the copayment assistance to count for deductibles and other cost-sharing in health plans.

“The new rule is a complete reversal of the administration’s policy announced last year that required copay assistance to count for brand name drugs” that don’t have generic equivalents, the organization said in a statement.