The Centers for Medicare & Medicaid Services May 7 issued a final rule that implements the standards governing health insurance issuers and the Health Insurance Marketplaces (or “exchanges”) for 2021.

In the rule, CMS finalized the benefit and payment parameters for qualified health plan issuers selling on the exchanges, as well as additional policies intended to lower premiums, promote program integrity, stabilize the individual and small group markets, enhance the consumer experience and reduce regulatory burden.

Also in the rule, CMS finalized value-based insurance design options that QHP issuers can choose to implement; updated how cost sharing calculations will account for drug manufacturer coupons; finalized small updates to medical loss ratio and special enrollment period rules; and increased the annual maximum out-of-pocket spending limits.

CMS did not finalize its proposal to require enrollees with no premium after a premium tax credit is applied to actively re-enroll or face reduced subsidies, consistent with AHA’s comments on the proposed rule.

Download the Special Bulletin for a summary of the key issues.

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