The Centers for Medicare and Medicaid Services (CMS) has extended the transitional policy to policy years beginning on or before October 1, 2019, provided that all such policies end by December 31, 2019.

On November 14, 2013, in response to backlash over widespread terminations of policies that didn’t comply with the ACA market reforms, CMS issued a letter to the State Insurance Commissioners outlining a transitional policy for non-grandfathered coverage in the small group and individual health insurance markets. If allowed by the state insurance commissioners, health insurance issuers may choose to continue certain coverage that would otherwise be cancelled due to the Affordable Care Act, and affected individuals and small businesses may choose to re-enroll in such coverage.

On April 9th, CMS extended that protection for another year. Grandmothered policies can now be renewed through December 31, 2019. The states and carriers will have to respond with regard to how they will handle their pre-ACA policies currently in force now that CMS has made this option available.

Also last week, CMS issued HHS Notice of Benefit and Payment Parameters for 2019. This aims to increase state flexibility, improve affordability, strengthen program integrity, empower consumers, promote stability, and reduce unnecessary regulatory burdens.

The final rule includes key provisions such as:

- Essential Health Benefits (EHB): States will have more flexibility in determining their benchmark plans.
- Exemptions: Expanded exemption categories for the Individual Mandate.
- Advanced Premium Tax Credit (APTC) Program Integrity: Requires Exchanges to implement stronger checks to verify applicants actually earn the income they claim to qualify for APTCs.

For more information on these policies, please contact brokersupport@martinins.com