The Centers for & Services (CMS) issued proposals for companies that will participate in the Marketplaces in 2017 that are aimed at improving the consumer experience, both when individuals for and when they use it.
With millions people turning to the , said Kevin Counihan, CEO the Marketplaces, the goal the proposed changes is to “make the Marketplaces work even better so that consumers will benefit from choice and competition.”
The proposal asks states to establish standards for adequate provider networks, subject to criteria CMS will establish.
CMS is evaluating additional ways to help consumers make informed decisions about the adequacy provider networks, including ways to indicate whether or not a plan has a broad number doctors and facilities.
To make it easier for consumers to compare , CMS is proposing to give issuers the option offering with standardized such as -sharing. Insurers could also continue to with more plan designs, so consumers can choose the plan that’s right for them.
In an effort to reduce surprise expenses to consumers, CMS is seeking comment on a requirement that include an estimate expenses for out-- services performed at an in- facility without advance notice.
For instance, if a patient who had surgery at an in- facility finds out later that their anesthesiologist was not the plan’s , -sharing charges for the anesthesiologist’s services would count toward the out--pocket maximum. Currently, these out-- -sharing charges do not count toward the out--pocket maximum.
Recognizing that many consumers need help understanding and using their after they enroll, CMS is asking for comment about expanding the role Navigators for such issues as appeals and applying for exemptions.
The proposed rule would also increase for employees in the federal () for plan years beginning in 2017 and beyond, to give more choices as they look for that best suits their employees.
Currently, participating in the federal can their employees either one plan and/or one dental plan, or all and dental across one metal tier. Under the proposal, would be able to all across all levels from one company.
Other issues for which CMS is seeking comments include:
- Streamlining direct so that customers can more easily use websites agents and brokers;
- to consumers more smoothly from to ;
- Updating the risk adjustment formula with current data;
- Improving the child age rating curve to more accurately price premiums; and
- Dates for the 2018 Open .
A detailed list the proposals is available online.