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Avalere’s Take on the Market Stabilization Final Rule

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Today, the Centers for Medicare & Medicaid Services (CMS) released its final rule for market stabilization of the health insurance exchanges, following the departure of some health plans from the marketplace for the upcoming plan year.

Recent Avalere analysis found that exchange enrollment has fallen well below initial projections. Additionally, Avalere data for 2017 exchange plans show that one in three regions in the U.S. will have no insurer competition. Recent analysis also finds an increase in premiums and out-of-pocket costs for consumers, in addition to a decrease in PPO plan options.

To address the concerns of health plans and consumers who purchase coverage through the exchanges, CMS’ final rule addresses the following:

  • Special enrollment periods
  • Guaranteed availability
  • Timing of the annual open enrollment period for the 2018 plan year
  • Network adequacy
  • Standards for determining actuarial value

“While CMS has taken steps to correct some of the current challenges in the marketplace, these changes likely are not significant enough to sway health plan decisions for the upcoming plan year,” said Cara Kelly, a vice president at Avalere Health. “Losing health plans from the exchanges is still a risk for 2018.”

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