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Regulators propose benefit reductions for standard bronze and silver plans; carriers favor limiting cost-sharing changes
Summary
State rulemaking staff said the division must reduce benefits for standard bronze and silver plans after a federal actuarial recalculation and presented options; carriers and marketplace staff generally favored options that minimize changes to member cost sharing, and written comments are due April 7.
State rulemaking staff told an advisory committee on March 31 that a federal recalculation of actuarial values shows the state'standard bronze and silver health plans are not in compliance and that benefits must be reduced to meet the new benchmark.
The committee'chair opened the meeting by saying the change stems from the "2027 actuarial value calculator" and that "we have determined that both the bronze and silver plans are no longer in compliance," requiring modifications to plan benefits.
For the standard bronze plan staff presented two options. Under Option 1, staff said the combined medical-and-drug deductible and the maximum out-of-pocket would rise from $9,200 to $10,200 and no other benefits would change. "Option 2" would increase those cost-sharing amounts by a smaller amount while also reducing some visit benefits, including primary care, specialist visits, outpatient rehab and habilitation, cardiac rehabilitation, and acupuncture and chiropractic.
Marketplace analyst Katie Button said she "prefer[s] option 1, because it doesn't increase cost sharing," and urged the committee to keep cost sharing low so members can continue to access benefits. Beau Wright of Providence Health Plan told the committee the carrier feedback he received was "consistent with" Button's view and that avoiding broad cost-sharing changes would be "less disruptive to our enrollees." Antoinette Uwachi, a RAC member representing carriers, said she supported the recommendation to limit changes in cost sharing. Theresa Varney of Moda Health agreed that smaller adjustments are easier for consumers to understand and have the least impact.
Staff then presented three options for the standard silver plan. Staff summarized the choices as: Option 1 would raise maximum out-of-pocket and increase some copays and specialist charges (the transcript contains unclear numeric values for some figures in Option 1); Option 2 would raise the maximum out-of-pocket from $9,200 to $10,700 while leaving other benefits unchanged; and Option 3 would raise the deductible, raise the maximum out-of-pocket (to a figure staff listed as $10,000), and increase specialist visit copays from $100 to $120.
Carriers again favored the option that limited changes to cost sharing. Wright and Uwachi supported Option 2; Button cautioned that many people enroll in the silver plan for prescription coverage and said it was important to keep preferred-brand drug costs lower. The chair said staff would accept written comments and set a deadline of close of business Tuesday, April 7, for written feedback.
Staff also reviewed the statement of need and fiscal impact required as part of rulemaking. The chair said the rule does not add new regulatory requirements beyond the changes to standard-plan language and that fiscal impacts to insurers would likely be limited to small increases in administrative costs. Staff noted and said they would correct a typographical error in the draft (changing "2065" to "2026") and reiterated that the proposed changes would affect consumers who purchase the standard bronze and silver plans in 2026 and 2027.
No formal motions or votes were taken during the meeting; staff said they would compile the committee's feedback and present a recommendation to the commissioner once written comments are reviewed.
Next steps: staff will circulate materials and a comment summary by email and present the committee's recommendation to the commissioner after the April 7 comment deadline.
