Newsletter

2025 MARKETPLACE INTEGRITY AND AFFORDABILITY PROPOSED RULE

The Centers for Medicare and Medicaid Services issued a proposed rule on March 10 designed to reduce fraud on the health insurance marketplace (healthcare.gov) and to lower opportunity for applicants to “game” the system and wait to enroll until they actually need to utilize health insurance. These changes aren’t finalized, but industry consensus is these changes will move forward in one form or another.

The announcement introducing the proposed regulations estimates there are opportunities to save between $11 and $14 Bn in 2027 as a result of reducing fraud in Affordable Care Act enrollments.

This fact sheet was issued on March 10. Proposed rules were published in the Federal Register on March 19, and the comment period on the regulations ends on April ll. Also, please see this article that appeared in the March 10 edition of Modern Healthcare.

Proposed changes include the following:

1.      Shorten marketplace open enrollment to the period November 1 to December 15 (from January 15); this is the same rule that was followed during the first Trump Administration. Shortening the enrollment period is described as one method of reducing the ability of individuals to wait until they are sick to enroll in a plan.

2.     Eliminate the special enrollment period rule that permits those making between 100 and 150% of the Federal Poverty Level from enrolling on a monthly basis. The proposed regulations also announce plans to eliminate the special election period the Biden Administration had instituted to permit people receiving benefits through the Deferred Action for Childhood Arrivals (DACA) program from enrolling in federally subsidized marketplace plans.

3.     The proposal announcement claims “data matching issues” increased about 300% from the end of the first Trump Administration to the second year of the Biden administration. The Administration plans to reinstate the proof of eligibility requirements that existed before COVID. Accordingly, it’s expected there will be much more scrutiny regarding projected income, citizenship, and residency and there will be significantly increased requirements for applicants to provide proof in support of their applications or else they will lose their subsidies or face a reduced subsidy.

4.     Consumers eligible for $0 premium (i.e., fully subsidized) plans who automatically renew their applications (this is called “passive” reenrollment”) may be required to pay $5/month until they verify their projected income. (Note: our practice has been to contact all our clients during annual enrollment to suggest they update their income projections and actively re-enroll in plans; accordingly, this change will have no effect upon our existing clients assuming they continue to actively re-enroll.)

Other proposed changes are currently under review. We will be monitoring those changes closely and will provide updates in this newsletter as changes occur.

“GO WILD:” SIXTY DAYS OF HEALTHCARE UNDER TRUMP

This article that appeared in Modern Healthcare on March 21 contains a listing of the most significant actions from the first 60 days of the second Trump administration.  The Administration has made changes to the nation’s healthcare and public health infrastructure but has yet to make major changes to Medicare and Medicaid and has only proposed one significant set of proposals regarding Affordable Care Act administration (see above article).

Late in his successful bid to reclaim the White House last year, Donald Trump said his soon-to-be Health and Human Services Secretary Robert F. Kennedy Jr. would “go wild on health.”

The president didn’t wait for Kennedy’s confirmation to get started.

The second Trump administration hit the 60-day mark on March 21. Trump and billionaire Elon Musk, who heads the White House’s “Department of Government Efficiency,” have taken an ax to the Health and Human Services Department and the rest of the federal government.

Trump also has reversed myriad policies from President Joe Biden’s administration, particularly those related to LGBTQ+ health and diversity, equity and inclusion.

The action has come at a torrid pace, whipsawing the healthcare sector. Although the administration has yet to make major changes to programs such as Medicare and Medicaid, the first two months of the new Trump presidency has brought significant change to the healthcare and public health infrastructure.

Click here for a timeline of the changes (with links including more information on some of the changes) the Administration has made so far.

HEALTH INSURANCE COVERAGE OPTIONS FOR COLLEGE STUDENTS

Read this informative article that appeared in the March 7 issue of Insure Guardian to learn more about the various health insurance options available to college students.



MARK CUBAN COST PLUS DRUG COMPANY CLIENTS SEE PROMISING EARLY RETURNS

Please see the Home Page of the Mark Cuban Cost Plus Drug Company. This company was established about three years ago and can provide significant savings on generic oral and topical medications. Medications are priced at cost plus a 15% handling fee, and drug prices on this site can be significantly lower than drugs cost through insured plans or discount sites like GoodRx and Single Care.

This article, published in the March 7 issue of Modern Healthcare reviews the considerable success Cost Plus Drugs has had since its inception.

About Paul Cholak

Paul has over forty years of benefits experience and has been Director of Employee Benefits for large companies, as well as a benefits consultant with major consulting firms. He understands the health and life insurance needs of individuals and families of all ages. He also has considerable experience in selling health and life insurance to employer groups.

He guides you through the steps of getting health and/or life insurance and is available to help you both BEFORE and AFTER you've made your purchase decision.