Public Payers News

ACA Enrollment Has New Star Ratings, Enhanced Direct Enrollment

For the ACA enrollment season, the federal health insurance marketplace will have star ratings, enhanced direct enrollment, and a brand new HRA option.

Affordable Care Act, federal health insurance marketplace, star ratings

Source: Getty Images

By Kelsey Waddill

- In 2020, the Affordable Care Act (ACA) enrollment process will feature quality star ratings, Enhanced Direct Enrollment (EDE), health reimbursement accounts (HRAs) resources, and a more streamlined experience in content and appearance on Healthcare.gov, according to CMS.

The new star ratings associated with exchange plans will be visible on Healthcare.gov. Star ratings will compile information regarding the plan’s medical care, member experience, and administration to rate each plan on a five-star system. Due to the complex process of collecting and analyzing the necessary data, stars will reflect the plan’s performance from two years ago.

With these new quality measures in place, CMS said that 80 percent of plans are eligible to receive three or more stars, which indicates that most plans are of average or above average quality.

CMS is also improving EDE.

Since Healthcare.gov crashed in 2014 when it could not handle the high level of initial enrollment, the federal government has approved enhanced direct enrollment pathways, alternative sites on which beneficiaries may enroll.

The agency is increasing the number of approved EDE vendors for 2020. Private sector partners run the five alternate sites, which have been heavily audited to ensure that their security standards meet CMS’s requirements.

For the first time, beneficiaries will be able to use EDEs throughout the open enrollment process this year.

CMS also added a “waiting room” which enrollees enter when traffic is too high on the site. They wait there and receive a message when the page has refreshed and is ready to let them navigate.

The third major update to the federal health insurance marketplace in 2020 is new HRA resources that CMS will make available.

The resources apply to individual coverage HRAs, which CMS introduced earlier this year. These HRAs allow beneficiaries to put their employers’ funds toward their individual health insurance marketplace premiums.

 The materials include a worksheet that helps beneficiaries discern whether an employer-funded individual coverage HRA is right for them.

Beyond these significant alterations, CMS also made changes to the site itself.

The agency streamlined the application process on Healthcare.gov, broadening the content available, making the information more integrated, and further optimizing the site for mobile use.

CMS also updated the website to make members’ experiences more consistent across the platform as they navigate and shop for plans.

The agency announced that it plans to maintain its 2019 marketing and outreach budget of $10 million.

CMS took a major risk in 2017 by slashing the marketing and outreach budget by 90 percent. The open enrollment process which used to take $100 million to accomplish, now had to get by on $10 million.

Enrollment declined slightly but remained fairly stable. From 12.2 million enrollees in 2017, the exchange lost about 400,000, with 11.8 million people enrolled in Affordable Care Act (ACA) federal marketplaces in 2018. In 2019, 11.4 million enrolled.

When open enrollment begins this year, CMS said it will focus on reaching young, healthy enrollees, presumably to absorb some of the risk posed by high-cost and chronically ill beneficiaries. The agency will use mediums such as YouTube, social media, and mobile platforms to encourage potential enrollees to consider the federal health insurance marketplace.

The marketing campaign will also target uninsured individuals, an expanding demographic in the national health insurance landscape. At the beginning of 2019, Gallup National Health and Well-Being Index stated that uninsurance levels in 2018 overshadowed the four prior years’ rates. Gallup estimated that 13.7 percent of the American adult population is uninsured.

The Census Bureau reported that uninsurance rose 0.5 percent to achieve an 8.5 percent uninsurance rate overall, which comprises 27.5 million individuals. If this were true, it would be the first major increase since 2010. However, since the Census Bureau released this information in September 2019, officials discovered an inaccuracy in the tax model and the 2018 SPM estimates are being reevaluated.

The agency’s marketing strategy communicates that CMS will have to focus on lowering uninsurance and bringing a healthier population onto the federal health insurance marketplace this open enrollment season.