The start of the 2021 rate review process for the Affordable Care Act (ACA) Marketplaces coincided with the initial outbreak of COVID-19 cases, and early forecasts were ominous, with rate increases projected as high as 40 percent. There was also widespread concern about how to set rates when insurers’ COVID-related costs looked anything but predictable. In short, it looked like, after a period of relative stability in Marketplace rates, enrollees might be in for a rollercoaster ride. This expert perspective provides a brief overview of how the rate review process has developed since the first ACA OEP in 2013 and how those developments came together this year to enable regulators and insurers to manage uncertainty and achieve more stable rates for the 2021 plan year.
Qualified Health Plan Review in Marketplaces with State Plan Management: An Analysis of the Division of Labor Between State Exchanges and Other State Agencies
Gabbie Nirenburg, JD, MS, and Arthur Thourson Jones, PhD, Leonard Davis Institute of Health Economics
States have implemented a variety of different methods to handle the review and certification of qualified health plans (QHPs). The Health Insurance Exchanges (HIX) Research Group at the Leonard Davis Institute of Health Economics at Wharton (LDI) recently collected data from 30 states, including those with State Based Marketplaces (SBMs), State Partnership Marketplaces (SPMs), Supported State Based Marketplaces (SSBMs), and Federally Facilitated Marketplaces (FFMs) with state plan management. This brief summarizes the findings within this dataset, which outlines the various plan management and certification functions assumed by different state agencies across these marketplace models.
The full dataset and codebook is available here. The dataset also highlights the role CMS plays in SPM, SSBM, and FFM with state plan management states.