CMS Announces a Temporary Policy for Premium Reductions

CMS Announces a Temporary Policy for Premium Reductions Option for Issuers to Temporarily Reduce Premiums for the remainder of 2020 Today, as part of the agency’s efforts to facilitate the nation’s response to the coronavirus disease 2019 (“COVID-19”) public health emergency (PHE), the Centers for Medicare & Medicaid Services (CMS) announced a policy that will allow issuers to offer temporary premium reductions for individuals with 2020 coverage in the individual and small group markets. CMS is providing this additional flexibility to help ensure that consumers struggling to pay their premiums can continue to be covered and receive the care they may need during this time. “Throughout the COVID-19 pandemic, the Trump Administration has taken a whole-of-America approach, including working with our private partners, to ensure that the entire healthcare system is activated in our efforts to protect the American people,” said Administrator Seema Verma. “Today’s action is just the latest in a series of flexibilities CMS has extended to health insurers to help them support their enrollees during this unprecedented time.” In light of the COVID-19 public health emergency, the Trump Administration is temporarily exercising enforcement discretion to allow issuers, when consistent with state law, to offer premium reductions for one or more months for 2020 coverage. This temporary policy will be in effect until the end of 2020. Issuers are generally prohibited under current federal requirements from changing premiums for health insurance coverage offered in the individual and small group markets after the start of the benefit year. Today’s announcement follows CMS’s adoption of several relaxed enforcement policies providing issuers the flexibility they needed to assist their enrollees impacted by the ongoing public health emergency. Under one of the enforcement policies CMS adopted, issuers that offer coverage through HealthCare.gov were permitted to extend premium payment deadlines and delay cancellation for non-payment of premiums. As another example, CMS adopted a non-enforcement policy that permitted issuers to prepay to enrollees a portion or all of the estimated Medical Loss Ratio (MLR) rebate for the 2019 MLR reporting year. To view the guidance, please visit: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Downloads/Premium-Credit-Guidance.pdf

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