CMS Continues Implementation of ACA's Premium Stabilization Programs

CMS has begun to implement risk adjustment and reinsurance programs, 2 premium stabilization programs of the Affordable Care Act (ACA). The report highlighted the estimated reinsurance payments issuer in addition to summary level information on the programs, which helps to keep premiums affordable as well as various coverage options available to consumers.

These premium stabilization programs help to secure a market of now guaranteed access that before the ACA denied coverage to people with preexisting conditions.

“These important programs are protecting consumers’ access to a wide range of affordable coverage choices in a new health insurance market in which no one can be denied coverage or charged higher premiums simply due to a pre-existing condition,” Kevin Counihan, chief executive officer of the Health Insurance Marketplaces, said in a statement. “The early results for the risk adjustment and reinsurance premium stabilization programs demonstrate that these programs are working as intended, which will help keep premiums stable and encourage insurance companies to compete on quality and price, not who can attract the healthiest enrollees.”

After several months of working with issuers and analyzing data submissions on premium stabilization programs, CMS found that a number of high-cost claim expenses were lower than expected and as a result, CMS announced it will pay 100% of eligible high-claims cost for the 2014 benefit year.

The report further detailed issuer’s risk adjustment charge or payment information and an early assessment of risk adjustment programs.