Regulatory Joe

How Healthcare.gov 2025 Changes Will Impact Your Health Plan Strategy

In this episode of Regulatory Joe, we break down the critical changes to Healthcare.gov that will reshape health plans in 2025. From streamlined enrollment to simplified plan selection, we dive into how these updates will impact issuers and plan operations in both federally facilitated and state-based marketplaces.

Duration:: 6m
Broadcast on:: 09 Oct 2024
Audio Format:: other

📌 Key Takeaways:

Consistent user experience across Healthcare.gov and state exchanges
Simplified plan selection to reduce confusion for enrollees
Best practices for testing and syncing plan data
And more!

🔔 Subscribe for more regulatory insights and health plan updates!

(gentle music) - Welcome to Regatory Joe, I'm Joe Boyle, the president of Regatory Solutions here at PennStock. And in today's episode, we'll be talking about healthcare.gov and annual changes that will impact you. So what is healthcare.gov? Healthcare.gov, if you don't know by now, is the primary shopping and enrollment space for members enrolling into any qualified health plan or ACA plan in the country. One of the primary changes CMS is enforcing for plan year 2025 is ensuring website consistency across state-based marketplace platforms as well as the federally facilitated marketplace. By enhancing the user experience and simplifying plan selection, it'll be very important for state-based marketplaces to align with direct enrollment and enhance direct enrollment policies and procedures that have been administered by CMS on the FFM. The primary reason that CMS is enforcing this policy change for plan year 2025 is to ensure both consistency for members enrolling within a healthcare.gov webpage as well as a state-based marketplace webpage and to increase the user experience for that member to effectuation of coverage. We encourage all issuers and all carriers across the country, if you haven't already, to register for the RegTap webinar sessions that outline the EDE and DE requirements for state-based marketplaces. It's gonna be very important to understand these rules and regulations to number one, see what CMS has changed on the website and administer the changes accordingly to your landing pages yourself, see what's changing with the enrollment and eligibility application and making necessary changes with your enrollment and billing partners for the SPM, and also ensuring and testing your user experience so that your plans are displaying accurately, timely and compliantly with the benefits that you intend to offer for plan year 2025 per CMS testing standards. All I has changed this year with how CMS has updated the MPMS process with how plans are tested and displayed, as well as how state-based marketplaces test and produce their shopping environments for members. Ensuring that these websites align and our synchronous will be critical to the delivery of your 11-1 enrollment and 1-1 effective date coverage. Similarly, there was an emphasis this year on simplifying plan selection. So in addition to aligning the web pages to CMS standards, regardless of the type of exchange you participate in, understanding that members for the first year ever will have less plans to choose from. When CMS released the latest MBPP for plan year 2025, there was a heavy emphasis on simplifying plan selection. Now, when we talk about updating the user experience of a member shopping on healthcare.gov or any state-based exchange shopping environment, it's really important to understand what a member sees. Prior to this year, members would be posed with hundreds of plans to choose from by reducing the number of standard plan options put forth by CMS, members will now see a simplified list of plans to choose from on the federal marketplace. So in logging in and completing their eligibility application, that'll be one of the first things that they see on the webpage on healthcare.gov. Now, while the filtering options still may be the same where you can filter by price, by brand, by company, by payer, members will have more of a simplified user experience and also working with navigators to pick the plan that meets their healthcare needs the most. Prior to this year, there have been too many times where members are pushed into plans or picking plans that are not the right fit for their health plan needs, or where they're either paying too much for services that are underutilized or not utilized at all. While making website updates can be seemingly frustrating at times, we do see that this is overall favorable to the member and will streamline policies and procedures internal to a health plan, as well as supporting quick enrollment and reporting on the federal exchange. So when we talk about recommendations on how to make this process smooth for your organization, there's a couple things to consider. At this point in the year, filings are being approved and disposed, you're likely starting the harvest process underway for submission and validation. All that data that you're working on currently, prior to open enrollment on November 1st, is going to be critical to plan tests, to plan validate and to anonymously shop all of your plans like a member would within both the federally facilitated marketplace environment, as well as any state-based marketplace environment that you currently have today. Now, while some people do spot check plans here and there, we do encourage you to do a full testing of every single plan within your portfolio to number one, make sure your benefits are displaying correctly, whether it's your PCP copays, specialist copays, even some of your additional benefits within your product, whether it's a program or an incentive that you're looking to offer a member. We also encourage you to take a hard look at your rates to make sure your premium rates by county or even zip code are matching the way a member would search. And if you do have time before 11.1, we do encourage you to bake in enough time to test, to make sure providers are returning the certain results within the facilities that you're covering, as well as certain prescription drugs are being covered when returned and the prescription drug directory as well. To make the most efficient testing process, we do recommend you wrap a timeline around this by developing a project plan. The beauty of developing a project plan this year will be this is an annual process and it'll be repeatable in the same time period next year, the following year and the following year after. And the really tricky part about healthcare.gov is in this transitionary period of the fall between your data being disposed with the state divisions of insurance, CMS, and then going live on healthcare.gov is the certification and approval process. Right now, as we move into the fall closer to 11.1, while carriers still may be trying to make changes to their planned portfolio, it does have to go through the rigorous DCR, also known as data change request process. So while carriers still may wanna make last minute changes through the DCR process up until 11.1, we encourage issuers not to make changes unless absolutely necessary, unless if it is a compliance change or a compliance risk to your product portfolio shelf for January one effective date. We also recommend that if you do have time in advance of 11.1, once your shopping experience testing has concluded, that you do check all of your non-marketplace websites to ensure that any product data live out there, whether it's internal to your own company landing pages or other partners or TPA's that you work with, are displaying your product and plan data correctly. While the focus of these changes put forth by CMS are with healthcare.gov, issuers must not forget where all of their other data does display outside of healthcare.gov. As we look to simplify healthcare for the members that we serve across the country, we do agree that these changes by CMS will be favorable to the user experience of enrolling into a qualified health plan. And we do expect to see more technical changes on healthcare.gov next year as well. Thanks again for listening to today's episode. Give us a like, give us a share, and we'll see you all next time. (upbeat music) (upbeat music)