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Marketplace cost-sharing reductions will still help eligible members in 2018

Key Takeaways

  • The federal government will no longer fund the cost-sharing reduction (CSR) program for ACA Marketplace plans.
  • BlueCross based 2018 plan rates with this possibility in mind and we will still cover those costs for eligible members.
  • Federal tax credits to help with monthly premiums are separate from the CSR program and will still be available in 2018.

Earlier this year, we shared information about how we set our individual plan rates for 2018. State regulators found that our proposed rates are justified based on what we expect to spend covering care for our members next year. And we have committed to offering plans in 6 of 8 regions for 2018.

Recently, the federal government announced it would no longer make payments to insurers for the cost-sharing reduction (CSR) program. The CSR program saved our members $88.9 million in 2016, and we know Tennesseans who buy coverage on their own may be wondering what this change means for them.

How the CSR program works to help members

  1. Members whose income is between 100 percent and 250 percent of the federal poverty level can qualify for cost-sharing reductions if they purchase a silver plan on the ACA Marketplace. (That’s $12,600 to $30,150 for a single person, or $24,600 to $61,500 for a family of four.)
  2. The program lowers their deductible and out of pocket maximum. (This is in addition to the tax credit that helps lower their monthly premiums.)
  3. We pay the difference on behalf of the member.

Before the latest announcement, the government reimbursed us for this program, but we’ll no longer receive those payments.

The good news: we’re ready to cover these costs

Before we set our 2018 rates, we knew there was a chance the government might not reimburse us for these costs. 

Two main factors are affecting our 2018 rates. Click here to read more.

The responsible thing for us to do was assume we wouldn’t get paid, and we set our rates to cover the costs on behalf of members who are eligible for the program.

If you’re eligible, don’t worry – you’ll keep saving on deductibles and out-of-pocket maximums. 

Factoring in the costs of the CSR program does mean rates for silver plans will be higher in 2018. But because of how the federal premium tax credits work, we expect many Tennesseans who qualify will have at least one plan option with a $0 monthly premium.

Marketplace enrollment for 2018 begins Nov. 1

If you have a BlueCross plan through the Marketplace, you should receive a letter with information on a recommended plan for 2018. The rate shown will not change based on this recent federal decision. However, if you receive a premium tax credit, the monthly payment amount shown on this letter is just an estimate. You should visit healthcare.gov to update your application and see how much financial help you qualify for in 2018.  

And don’t forget that open enrollment is Nov. 1 through Dec. 15. If you need help selecting a plan, you can contact our sales team at 888-995-7786, a certified application counselor, an enrollment assistor, or a licensed broker or agent.

About Kelly Paulk, Vice President, Product Strategy and Individual Markets

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Kelly oversees product strategy for employer group and individual customer markets, provides leadership to operations, sales and strategic marketing areas and serves as the point person for regulatory, compliance and audit processes for the individual product line.

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