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CMS wants to cut ACA exchange fees, end silver-loading

The CMS issued a proposed rule on Thursday that would cut Affordable Care Act user fees and laid the groundwork to eliminate “silver-loading.”

In its proposed notice of benefit and payment parameters for ACA exchanges in 2020, the agency proposed reducing the exchange user fee that is charged to health insurers to fund the health insurance exchanges. That would help lower consumer premiums in 2020, the agency said.

The CMS also noted that the Trump administration supports a legislative solution that would appropriate funding for cost-sharing reduction payments, which the administration ended in 2017. It also supports ending the practice of “silver-loading.”

The agency asked stakeholders to comment on ways the federal government might address silver-loading in future rules no sooner than 2021.

Silver-loading refers to when health insurers loaded premium increases into the popular silver-level exchange plans to make up for the loss of CSR payments. Loading premium surcharges onto silver plans boosted the size of the premium tax credits available to people with incomes below 400% of the federal poverty level.

The CMS’ proposed rule also included allowing individual, small group and large group insurers to adopt mid-year prescription drug formulary changes to encourage members to use lower-cost generic drugs. The proposal would further allow insurers to except cost-sharing from the maximum out-of-pocket limit when a plan member selects a brand name drug when a generic alternative is available.

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