CMS-10527 - Response to comment

Comment and Response Summary:

Annual Eligibility Redetermination, Product Discontinuation and Renewal Notices

(CMS-10527/0938-1254)

A Federal Register notice was published on April 17, 2023 (88 FR 23429), providing the public with a 30-day period to submit written comments on the information collection requirements. CMS received comments from two commenters.

General Comments

Comment: Two commenters stated that CMS should permanently adopt the Enforcement Safe Harbor providing flexibility around renewal notices so health insurance providers can direct people to the Marketplace to obtain exact information about their premium and subsidy amounts and make well-informed decisions about their health care. Current policy and timing for CMS and IRS processes to communicate updated information about subsidy eligibility means consumers will continue to receive outdated and often inaccurate information about their subsidy eligibility and premiums in renewal notices unless the safe harbor is extended. Current policy and timing for CMS and IRS processes to communicate updated information about subsidy eligibility means consumers will continue to receive outdated and often inaccurate information about their subsidy eligibility and premiums in renewal notices unless the safe harbor is extended.

Response: CMS believes that providing cost estimates for the following year in the renewal notices, although they might be imprecise, provides valuable contextual information to individuals, at the very beginning of the Open Enrollment period, to help them start the process of thinking about and weighing their coverage options, and might prompt some individuals to contact the Marketplace to update their information.

Comment: One commenter observed that CMS states in the 2024 Payment Notice final rule that it will provide additional communications to enrollees impacted by the Bronze-to-Silver crosswalk policy. CMS should share sample notices prior to Open Enrollment and the timeline for sending these notices so issuers can prepare their customer service channels and align messaging to provide better support to consumers.

Response: CMS plans to publish the sample notices that will be sent to enrollees reenrolled in Silver plans under the Bronze-to-Silver reenrollment policy finalized in 155.335(j) of the 2024 Notice of Benefit and Payment Parameters¹ prior to the start of Open Enrollment, as well as information about when these notices will be sent to consumers. CMS will also provide technical assistance to stakeholders, including Marketplace issuers, to ensure awareness and understanding of these communications.

Comment: One commenter asked CMS to clarify whether certain Bronze plan enrollees with pre-tax health savings accounts (HSAs) and catastrophic plan enrollees will be subject to the Bronze-to-Silver crosswalk policy, and if so, whether they will receive additional communications from the Exchanges about their re-enrollment into a Silver plan.

Response: Per 45 CFR 155.335(j)(4), the Bronze-to-Silver reenrollment policy finalized in the 2024 Notice of Benefit and Payment Parameters does not apply to enrollees enrolled in catastrophic plans. Enrollees in any Bronze plan may be auto re-enrolled into Silver plans consistent with the hierarchy at 45 CFR 155.335(j), regardless of whether the Bronze plan is HSA-eligible. These enrollees will receive communications encouraging them to return to the Marketplace to actively select a plan if they wish to do so, and we also encourage agents and brokers and Assisters to work with these enrollees to ensure they can make informed decisions on this matter.

Comment: One commenter observed that, as drafted, all consumers enrolled in a Bronze plan are informed that their exchange may enroll them in a Silver, which would change both their premiums and cost-sharing. However, 3 issuers who incorporate their exchange’s 2024 batch auto reenrollment (BAR) information into their renewal and discontinuation notices can inform their Bronze members exactly what plan they will be enrolled in for 2024. Just as CMS allows such issuers to communicate accurate net premium information that includes the recalculated 2024 Advance Premium Tax Credit amounts, CMS should also allow them to communicate auto-assigned 2024 plan information rather than suggesting members “may” be reenrolled into another plan.

Response: CMS has revised Attachments 2 and 4 to address this comment. .

Comment: One commenter recommended that, because the Bronze-to-Silver crosswalk has potential to significantly change enrollees’ premiums and cost-sharing, all issuers should have flexibility to move the paragraph describing the potential crosswalk to the first page of the notice. More prominent placement of this potential plan change information is especially important if issuers are required to include outdated premium estimates for a Bronze plan which may not apply in the upcoming year.

Response: Notwithstanding the importance and significance of the information regarding the Bronze-to-Silver reenrollment policy, CMS believes that all the information that precedes it in the draft notices should appear before the Bronze-to-Silver reenrollment information, to first provide the overall context for the notice.

Comment: Two commenters recommended that CMS finalize templates in June 2023 to ensure issuers have sufficient time to complete renewal and discontinuation notices, including testing, printing, and mailing.

Response: CMS anticipates receiving PRA approval for final templates in June 2023.

Comments requesting specific changes to language.

One commenter requested a number of specific changes to the draft notices, asserting that the changes would make the language less confusing, and would add consistency and clarity. The table below lists each such comment. CMS believes the changes are not necessary and would not materially improve the readability or clarity of the notices. However, CMS reminds issuers that they are permitted to include clarifications, additional information, and instructions for special situations in a cover letter.

Comment

Attachments 2, 4, and 6:

Simplify the current language around the Bronze-to-Silver crosswalk to be more consumer-friendly. For example: [21 For enrollees currently enrolled in a Bronze level QHP and the new plan to which the premium information above applies, is a Bronze level QHP, insert]: Important: If you don’t take action by December 15 and currently have a Bronze category plan and qualify for extra savings, [22 Exchange] may enroll you in a Silver plan from [23 issuer] so you’ll get the most help to lower your costs in [24 Year]. The Silver plan has the same network and an equal or lower monthly payment as the new plan, but covers more of your out-of-pocket costs, like copayments, coinsurance and deductibles. Enrolling in this (or another) Silver plan may save you thousands of dollars each year. [25 Exchange] may contact you about [26 this and] other reenrollment options if you don’t choose a different plan on your own during open enrollment.

Attachment 1: In “Why am I getting this letter?” section:

Modify language to read: Unless you take action by [7 Date], we’ll automatically re-enroll you in the same or similar plan for [8 Year].

Attachment 1: In “What you need to do” section:

Change boxes to bullets to reduce consumer confusion and simplify formatting.

Attachment 1: In “What you need to do” section:

Modify language to read: “Pay the new monthly premium by the due date on your bill” instead of inserting a due date. There are many variables that could impact the actual due date.

Attachment 1: In “What you need to do” section:

Add language after “Enroll by [33 Date] for coverage to start [34 Date].]” to match language in Attachment 2: “If you choose a plan between [December 16 or December 31] and [January 15 or January 30], the new plan will start February 1.]”

Attachment 2: In “Your New Premium” section:

Modify language to read: “Starting in [Month], your new monthly premium will take effect. Log in to [Exchange] on or after November 1, 2023, to see your 2024 health plan monthly payment. It may be different from your current monthly payment because your financial help may change in [Year]. Your [Month] bill will show your new monthly payment that includes any financial help you are qualified to receive in 2024.”

Attachment 2: In “Your New Premium” section:

Modify language to read: [21 For enrollees currently enrolled in a Bronze level QHP and the new plan is a Bronze level QHP, insert]: Important: If you currently have a Bronze category plan and qualify for extra savings, [22 Exchange] may enroll you in a Silver plan from [23 issuer] so you’ll get the most help to lower your costs in [24 Year]. The Silver plan has the same network and an equal or lower monthly payment as the new plan to which the premium information above applies, but covers more of your out-of-pocket costs, like copayments, coinsurance and deductibles. Enrolling in this (or another) Silver plan may save you thousands of dollars each year.

Attachment 2: In “Your New Premium” section:

Specify what types of communications the Exchange will be using (i.e., letter, email, phone call) to contact consumers: [25 Exchange] may contact you about [26 this and] other reenrollment options if you don’t choose a different plan on your own during open enrollment.

Attachment 2: In “What you need to do” section:

Change boxes to bullets to reduce consumer confusion and simplify formatting.

Attachment 2: In What you need to do” section:

Allow issuers the option to insert “between December 31 and January 31” to match states with extended due dates here: “[41 Issuers on the Federally-facilitated Exchange or on a State-based Exchange on the Federal platform, insert: If you choose a plan between December 16 and January 15, the new plan will start February 1.]”

Attachment 3: In “What do you need to do” section:

Change boxes to bullets to reduce consumer confusion and simplify formatting.

Attachment 3: In “What do you need to do” section:

Add language after “You can choose a different plan between [35 Dates]. Enroll by [36 Date] for coverage to start [37 Date].” to match language in Attachment 2: “If you choose a plan between [December 16 or December 31] and [January 15 or January 30], the new plan will start February 1.]”

Attachment 4:

Recommend the same changes as suggested for Attachment 2.

Attachment 6:

In “What do you need to do” section:

Consider rewording the following sentence to better encourage consumers action and plan selection: “If you don’t enroll in a plan on your own, [20 Exchange] may automatically enroll you in a plan it picks for you.”

1 88 FR 25740.

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