Payers, providers to CMS: Don’t end silver loading

Affordable Care Act highlighted
Payers told CMS that it shouldn't block silver loading without reinstating CSRs. (Getty/Ellenmck)

Payers and providers are urging CMS to continue to allow so-called silver loading, absent a plan to reinstate cost-sharing reduction payments for ACA exchange plans.

The Centers for Medicare & Medicaid Services requested feedback on the practice in its annual Notice of Benefit and Payment Parameters proposal, which sets regulatory requirements for qualified health plans on the Affordable Care Act exchanges.

In a comment letter (PDF) to the agency, America’s Health Insurance Plans said CMS should continue to allow states to decide whether to allow silver loading, a perspective that was echoed by major insurers like Anthem, the Blue Cross Blue Shield Association and Cigna.

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“HHS should continue to provide states the flexibility to permit silver loading to ensure eligible consumers receive CSR benefits,” AHIP said.

Many insurers responded to the Trump administration’s decision to end CSRs through silver loading, in which they would put most premium increases on silver plans. These plans are used as the benchmark to determine federal subsidies, so silver loading provided an alternative path to reduced cost-sharing.

In the NBPP proposal, CMS signaled that it’s open to a legislative fix to the problem—even potentially to reinstating the CSR payments.

RELATED: Mandate against ‘silver loading’ not likely during next ACA enrollment

In its comment letter (PDF), Cigna warned that eliminating silver loading could destabilize the ACA marketplaces and make plans more expensive.

“State regulators are in the best position to identify which rating practices will best protect consumers in their states, and most states have encouraged silver loading,” Cigna said.

Provider groups also echoed the sentiment in comments to CMS. Forcing insurers to spread premium increases across bronze, silver and gold plans could lead to an additional cost barrier in a market that can already be costly for some, the American Hospital Association said (PDF).

“Spreading the cost across all plans would raise the cost for both subsidized and unsubsidized enrollees and may create a cost barrier for some consumers,” the AHA wrote in its letter. “We urge the agency not to threaten consumers’ access to coverage or the stability of the marketplaces by taking any action to address silver loading.”

Payers also call for CMS to leave automatic re-enrollment polices in place

In the notice, CMS also requested feedback on current automatic re-enrollment policies. The agency said it was concerned that the practice could have unintended consequences, such as increased wasteful spending, even though the goal was noble.

In its comments, AHIP said the automatic process prevents coverage lapses and eases administrative burdens, and so CMS should leave it alone and should instead focus in other areas, such as data matching improvements, to reduce spend.

“HHS has invested significant resources and worked tirelessly in partnership with health insurance providers to make this a smooth experience for consumers, to minimize gaps in coverage, and mitigate administrative burdens for exchanges and health insurance providers,” AHIP said. “We strongly urge HHS to continue to leverage these efforts and maintain auto re-enrollment.”

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

Other payers expressed similar concerns. BCBSA said that ending automatic re-enrollment would disrupt coverage for 3 million people, and Anthem said it could confuse consumers and boost premiums.

“Ending or modifying auto re-enrollment would have serious, negative consequences for consumers, issuers, brokers and exchanges,” Anthem said.

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