CMS adds another year to the life of ACA grandfathered plans 

Health insurance form payer plan enroll
CMS has released new data on the 2019 open enrollment period. (Valeriya/Getty)

CMS has issued new guidance aimed at extending the life of “grandfathered” ACA plans. 

The Trump administration issued a request for information last month on how it could support grandfathered Affordable Care Act plans in the group market. These plans were available before the ACA became law in 2010 and are generally not compliant with the ACA’s coverage requirements. 

The White House extended the life of these plans in 2017, and under the new guidance (PDF), the Centers for Medicare & Medicaid Services has tacked on an additional year for the grandfathered plans before they must become ACA compliant. 

Free Webinar

Take Control of Your Escalating Claim Costs through a Comprehensive Pre-payment Hospital Bill Review Solution

Today managing high dollar claim spend is more important than ever for Health Plans, TPAs, Employers, and Reinsurers, and can pose significant financial risks. How can these costs be managed without being a constant financial drain on your company resources? Our combination of the right people and the right technology provides an approach that ensures claims are paid right, the first time. Register Now!

Under the guidance, states will be able to choose whether to extend grandfathered plans for a full year or less than a year, and whether to extend that to such plans in the individual market, small group market or both. 

CMS Administrator Seema Verma said in a statement that ending the grandfathered plans would take away affordable coverage that meets the needs of plan members. 

“Not extending the grandmothered plan policy would cancel plans that are meeting people’s needs today and, as a result, force people to choose between buying coverage they cannot afford on the individual market, or going uninsured,” Verma said. 

RELATED: CMS seeking feedback on ways to address ACA exchange ‘silver loading’ 

The availability of grandfathered plans is on the decline, according to research from the Kaiser Family Foundation. Just 20% of employers offered such a plan in 2018, down from 23% in 2017. Just 16% of workers enrolled in one of these plans last year, KFF found. 

The Trump administration has prioritized offering alternatives to ACA exchange plans, and has extended the length of short-term coverage and expanded association health plans

CMS releases final 2019 open enrollment data

About 11.4 million people enrolled in an ACA exchange plan, either through Healthcare.gov or their state marketplace, according to the latest CMS data. This marks a slight downturn in enrollment from 11.8 million people in 2018. 

RELATED: Final Healthcare.gov enrollment numbers show drop due to cancellations 

Premiums on Healthcare.gov declined from an average of $621 before tax credits in 2018 to $612 before tax credits in 2019, CMS said. A significant majority (87%) of people enrolling through Healthcare.gov for 2019 qualified for premium tax credits. 

About 24% of those who enrolled on the exchanges in 2019 were new customers, a decrease from 27% for the 2018 plan year. 

Still, CMS said the results were encouraging and highlight the agency’s hard work to ensure a positive customer experience. 

“Another year of stable enrollment through the exchanges directly reflects the strong work CMS staff put into ensuring that exchange consumers experience a seamless enrollment process free from unnecessary hurdles and IT glitches,” Verma said. 

Suggested Articles

Here's how the state of Iowa ramped up its efforts to address the social needs of at-risk mothers and children.

CVS Health has tapped a new executive to head its retail pharmacy segment.

AdventHealth has partnered with biotech firm Berg to gain insights on people that have tested positive for COVID-19 and reduce mortality rates.