Health Affairs April 11, 2018
The Centers for Medicare and Medicaid Services (CMS) finalized the Benefit and Payment Parameters rule for 2019 on April 9, 2018. An earlier post addressed the rule’s changes in plan benefits, eligibility, and enrollment. This post considers the rate review provisions, the medical loss ratio, the general market reforms, and the SHOP exchanges. A third post will cover the rule’s provisions on risk adjustment.
Rate Review
Since 2011, issuers have been required to submit rate filing justifications for rate increases for non-grandfathered plans in the individual and small group market. This requirement was established to carry out CMS’ responsibility to monitor premium increases for insurance offered inside and outside the exchanges. The final rule adopts a number of changes relative...
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