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CMS Gives More Flexibility to States When Regulating Health Insurance


The Centers for Medicare & Medicaid Services released the final Notice of Benefit and Payment Parameters (NBPP) for the 2019 plan year.

This annual rule, released today, updates guidance and regulations related to exchanges as well as the broader individual, small group, and large group insurance markets.

The final NBPP:

  • Builds on recent efforts to increase health plan and state flexibility to spur participation and product innovation while amplifying the role of states in reviewing and monitoring plans;
  • Allows for greater essential health benefit flexibility, which could lead to less generous benefits and worse access for consumers; and
  • Adjusts out-of-pocket maximums (MOOP) to $7,900 for individual coverage and $15,800 for family coverage. The increase (7%) is the highest annual MOOP increase since 2014.

“Given the repeal of the individual mandate and other recent market changes, this year’s final NBPP provides additional insight into what we can expect in 2019,” said Kelly Brantley, vice president at Avalere. “Going forward, we expect that the administration will continue to focus on granting flexibilities involving essential health benefits, exchange requirements, and benefit design.”

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