The aim of the policy is to prevent care disruption for the 8 million consumers who got coverage through exchange plans during the Patient Protection and Affordable Care Act's first enrollment period, and to avoid losing a large number of them while the administration works to extend coverage to most of the nation's uninsured.
But easing the path to re-enrollment could mean some of those consumers lose tax credits or pay higher premiums. If an insurer has decided to discontinue a particular plan, the carrier has the leeway to automatically enroll its members in a plan deemed similar, even though it could have a higher or lower actuarial value (represented by the metal tiers bronze, silver and gold). Carriers also could enroll those members in an ACA-compliant plan that's not sold on an insurance exchange.
The CMS received several comment letters on the proposed policy noting that enrolling an individual for any coverage other than an identical plan would cause confusion and unforeseen consequences. Some letters warned that enrollees might lose access to cost-sharing reductions they received under a silver plan if they are re-enrolled into a plan at a different metal tier, and they could become ineligible for cost-sharing and tax credits if they're shifted to a plan outside the exchange, according to the CMS' summary of the comments.
The agency countered that it expects there will be few people who will unable to return to their identical plan, and that the rule lays out a series of steps insurers must take to mitigate such problems.
However, the agency acknowledged some people could fall through the cracks. For instance, it said it would need to release future guidance on how a plan would ensure the continuity of cost-sharing provisions when consumers are transferred outside an exchange. The CMS also said it would need to release additional guidance that explains what insurers should do when its members move outside of their original plan's service area or age out of a parent's policy.
“We reiterate that enrollees have the opportunity to shop for a new plan during the open-enrollment period, regardless of whether they are automatically re-enrolled into a plan that does not meet their needs,” the CMS said in the final rule.
While the rule generally allows insurers to decide which plans qualify as similar substitutes, the CMS will allow state-based exchanges to make that call if they choose.
Groups that have been enrolled through outreach efforts applauded the administration's decision to finalize the policy.
“I'm glad that auto-enrollment is there for folks who are happy with what they chose,” said Ryan Baker, vice president for health policy at the Missouri Foundation for Health, which spearheaded an effort to get residents enrolled in that state.