Wednesday, September 3, 2014

CMS Finalizes Auto-Enrollment Process for Current Marketplace Consumers

The Centers for Medicare & Medicaid Services (CMS) finalized a policy that provides current Health Insurance Marketplace consumers with a simple way to keep their current health insurance plan.  This policy encourages current marketplace consumers to return to the Marketplace to ensure they are getting the best deal on their premiums and to shop for the plan that best fits their needs. These policies build on our efforts to enhance the consumer experience and make shopping for health care coverage as simple as possible.

Consumers in the Federally-facilitated Marketplace will receive notices from the Marketplace shortly before open enrollment begins explaining the auto-enrollment process and to encourage consumers to the Marketplace to see if they qualify for additional financial assistance and to shop for plans. Consumers will also receive notices from their insurance company about their new 2015 premium and the amount they may save on their monthly bill with a premium tax credit. 

As part of the renewal process in the Federally-facilitated Marketplace, generally, if consumers do nothing, they will be auto-enrolled in the same plan with the same premium tax credit and other financial assistance, if applicable, as the 2014 plan year.  Consumers are encouraged to return to the Marketplace to make sure they are getting all the financial assistance they qualify for, and to shop for the plan that best suits their needs. Consumers whose 2013 tax return indicates that they had very high income, or who did not give the Marketplace permission to check updated tax information for annual eligibility redetermination purposes will get auto-enrolled without financial assistance if they do not return to  This process will help provide continuity of coverage and safeguard taxpayer dollars.  The policies announced today give state-based Marketplaces the flexibility to propose unique approaches to this process that may better meet their specific state needs, while keeping a streamlined consumer experience the focus.

The CMS fact sheet is available here
The final rule is available here
The final issuer notices guidance will be posted here later today:

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