On November 15, 2023, the Centers for Medicare & Medicaid Services released its proposed 2025 Notice of Benefit and Payment Parameters, the annual regulation which governs core provisions of the Affordable Care Act. This expert perspective focuses on aspects of the proposed rule likely to be of interest to state officials, including requirements for State-Based Marketplaces to align with the standards of the Federally Facilitated Marketplace, proposals for states to update essential health benefits, and initiatives to ease the eligibility and enrollment process for consumers.
Design Considerations in Structuring Employee Choice for SHOP Exchange
Wakely Consulting Group
The Affordable Care Act (ACA) created the Small Business Health Options Program (“SHOP”) to create new marketplaces for small employers (and employees) to shop for and purchase employer subsidized health insurance coverage. In addition to small business tax credits, the primary value proposition for the SHOP is to facilitate employee choice. Wakely Consulting Group has prepared a brief highlighting the design approaches to SHOP that allow employers to provide a defined contribution while giving employees the choice of one or more products offered on the SHOP. Under this defined contribution approach, the employer’s main responsibility is a financial contribution toward employees’ health insurance premiums, which the employee can put toward the purchase of the coverage that he/she chooses. The brief walks through the different employee choice models and two distinct risk selection impacts and how to address them. Finally, it touches on five design variable for an exchange to consider in order to minimize consumer confusion and adverse risk selection.