Health Insurance Market Reforms

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menu-item--collapsed"> <a href="/medicare/medicaid-coordination/center-program-integrity/resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/674936">Resources</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/medicaid-coordination/about/qualified-medicare-beneficiary-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/184631">Qualified Medicare beneficiary program</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/medicaid-coordination/center-program-integrity/spotlight" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/674941">Spotlight</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/medicaid-coordination/center-program-integrity/events" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/674946">Events</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicaid-chip/medicare-coordination/financial-alignment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/178246">Financial alignment initiative</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicaid-chip/medicare-coordination/avoidable-hospitalizations" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/181236">Initiative to reduce avoidable hospitalizations </a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/medicaid-coordination/center-program-integrity/reports-guidance" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/674951">Reports & Guidance</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/medicaid-coordination/pace" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175651">Program of All-Inclusive Care for the Elderly (PACE)</a> </li> <li class="menu-item 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<a href="/medicare/appeals-grievances/managed-care" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169961">Managed Care appeals & grievances</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/appeals-grievances/prescription-drug" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171101">Medicare Prescription drug appeals & grievances</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/appeals-grievances/ombudsman-center" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193386">Ombudsman Center</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/appeals-grievances/appeals-decision-search-part-c-d" class="menu-item-element" aria-current="false" data-drupal-link-system-path="qic-decision-search">Appeals Decision Search (Part C & Part D)</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Quality</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/value-based-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/188566">Value-based programs</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/quality/initiatives/hospital-quality-initiative/person-family-engagement" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/182996">Person & Family Engagement</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/quality-improvement-organizations" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169871">Quality improvement organizations</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/nursing-home-improvement" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171236">Nursing home quality improvement</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/inpatient-rehabilitation-facility" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175616">Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP)</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/home-health" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170541">Home Health Quality Reporting Program</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/end-stage-renal-disease-esrd-quality-incentive-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176126">ESRD Quality Incentive Program</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/meaningful-measures-initiative/cms-quality-strategy" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/178276">CMS National Quality Strategy</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/hospice" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175556">Hospice Quality Reporting Program</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/long-term-care-hospital" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175511">Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP)</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/appropriate-use-criteria-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/180421">Appropriate Use Criteria Program</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/measures" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172001">Quality measures</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/clinical-laboratory-improvement-amendments" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172651">Clinical Laboratory Improvement Amendments (CLIA)</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/advantage-quality-improvement-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/177561">Medicare Advantage quality improvement program</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/physician-compare-initiative" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175221">Physician compare initiative</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/initiatives" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169636">Quality initiatives</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-drug-plans/part-c-d-performance-data" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171491">Part C and D Performance Data</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/snf-quality-reporting-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/180061"> Skilled Nursing Facility (SNF) Quality Reporting Program (QRP)</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Health & safety standards</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-safety-standards/quality-safety-oversight-general-information" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169631">Quality, safety & oversight - General information</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-safety-standards/accreditation-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171481">Accreditation programs</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-safety-standards/civil-monetary-penalties" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/182431">Civil monetary penalties</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-safety-standards/quality-safety-oversight-emergency-preparedness" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172346">Quality, safety & oversight - Emergency preparedness</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-safety-standards/state-survey-agencies" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171271">State survey agencies</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-safety-standards/certification-compliance" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171241">Certification & compliance</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-safety-standards/enforcement" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169811">Enforcement</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-safety-standards/guidance-for-laws-regulations" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170071">Quality, safety & oversight - Guidance for laws & regulations</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-safety-standards/promising-practices-project" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172211">Promising practices project</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-safety-standards/education-division" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/173371">Quality, safety & oversight - Education division (QSED)</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-safety-standards/conditions-coverage-participation" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172616">Conditions for coverage & participation</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Employers & plan sponsors</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/employers-plan-sponsors/creditable-coverage" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171701">Creditable coverage</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2"> <span class="menu-item-element" aria-current="false">IC-Placeholder-1</span> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Audits & Compliance</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/audits-compliance/part-a-cost-report" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/185256">Part A cost report audit</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/audits-compliance/part-c-d" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175921">Part C/Part D compliance & audits</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Forms & notices</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/medicare/forms-notices/cms-forms" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170166">CMS forms</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/forms-notices/cms-forms-list" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/174306">CMS forms list</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/forms-notices/beneficiary-notices-initiative" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170686">Beneficiary Notices Initiative (BNI)</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Health & drug plans</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-drug-plans/plan-payment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171981">Plan payment</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-drug-plans/plan-payment-data" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175081">Plan payment data</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-drug-plans/medical-loss-ratio" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/180161">Medical loss ratio</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-drug-plans/coverage-gap-discount-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175906">Coverage Gap Discount Program</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-drug-plans/managed-care-marketing" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170611">Managed care marketing</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-drug-plans/medicare-advantage-application" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170651">Medicare Advantage application</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-drug-plans/medigap" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170466">Medigap (Medicare supplement health insurance)</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-drug-plans/medical-savings-account" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172066">Medical Savings Account (MSA)</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-drug-plans/private-fee-for-service-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170301">Private Fee-for-Service Plans</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/enrollment-renewal/health-plans/prepayment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170521">Health Care Prepayment Plans (HCPPs)</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/enrollment-renewal/health-plans/cost" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170656">Cost plans</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/enrollment-renewal/special-needs-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171676">Special needs plans</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-drug-plans/network-adequacy" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171301">Network adequacy</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Coordination of benefits & recovery</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/overview" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/177001">Overview</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/mandatory-insurer-reporting-group-health-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176856">Mandatory Insurer Reporting for Group Health Plans (GHP)</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/mandatory-insurer-reporting" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176951">Mandatory insurer reporting (NGHP)</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/workers-comp-set-aside-arrangements" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176641">Workers' comp Medicare set aside arrangements</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/attorney-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/177026">Attorney services</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/beneficiary-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/177036">Beneficiary services</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/coba-trading-partners" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176761">COBA Trading Partners</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/employer-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170361">Employer services</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/insurer-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170846">Insurer services</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/prescription-drug-assistance-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176791">Prescription drug assistance programs</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/provider-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170406">Provider services</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Settlements</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/medicare/settlements/jimmo" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193381">Jimmo Settlement</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/settlements/ryan" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193486">Ryan Settlement</a> </li> </ul> </div> </div> </li> </ul> </div> </li> <li class="menu-item menu-item--l1 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Medicaid/CHIP</span> <div class="subnav-wrapper--1 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-main ds-u-lg-display--none">Back to main menu</span> <h2 class="subnav-title-h2" style="position:relative;text-align:left;width:auto;height:auto;">section title h2</h2> </div> <ul class="menu"> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">What is Medicaid?</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="https://www.medicaid.gov" class="menu-item-element" aria-current="false">Visit Medicaid.gov</a> </li> <li class="menu-item menu-item--l3"> <a href="https://www.medicaid.gov/about-us/beneficiary-resources/index.html#statemenu" class="menu-item-element" aria-current="false">View Medicaid maps</a> </li> <li class="menu-item menu-item--l3"> <a href="http://www.medicaid.gov/chip/index.html" class="menu-item-element" aria-current="false">Visit CHIP.gov</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Medicare-Medicaid Coordination</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/medicaid-chip/medicare-coordination/integrated-care-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/174926">Integrated care resources</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicaid-chip/medicare-coordination/avoidable-hospitalizations" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/181236">Initiative to reduce avoidable hospitalizations</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicaid-chip/medicare-coordination/financial-alignment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/178246">Financial alignment initiative</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicaid-chip/medicare-coordination/integrity-institute" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1315141">Medicaid Integrity Institute</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2"> <span class="menu-item-element" aria-current="false">RG-Placeholder-1</span> </li> <li class="menu-item menu-item--l2"> <span class="menu-item-element" aria-current="false">IC-Placeholder-2</span> </li> </ul> </div> </li> <li class="menu-item menu-item--l1 menu-item--expanded menu-item--active-trail"> <span class="menu-item-element" aria-current="false">Marketplace & Private Insurance</span> <div class="subnav-wrapper--1 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-main ds-u-lg-display--none">Back to main menu</span> <h2 class="subnav-title-h2" style="position:relative;text-align:left;width:auto;height:auto;">section title h2</h2> </div> <ul class="menu"> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">About the Marketplace</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/about/oversight" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191061">Marketplace oversight</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/about/affordable-care-act" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191416">Affordable Care Act</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/about/overview-exchanges" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190921">Overview of the exchanges</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/about/exchange-coverage-maps" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193086">Exchange coverage maps</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/about/medicare" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/179351">Medicare and the Marketplace</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Private Health Insurance</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/patient-bill-of-rights" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192591">Patient’s Bill of Rights</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/medical-loss-ratio" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190956">Medical loss ratio</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/annual-limits" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191976">Annual limits</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/review-insurance-rates" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192716">Review of insurance rates</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/market-rating-reforms" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191816">Market rating</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/self-funded-non-federal-governmental-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191111">Self-funded, non-federal governmental plans</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/grandfathered-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191456">Grandfathered plans</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/health-reimbursement-arrangements" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193216">Health Reimbursement Arrangements</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/coverage-young-adults" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190931">Coverage for young adults</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/student-health-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190946">Student health plans</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/mental-health-parity-addiction-equity" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192601">Mental health parity and addiction equity</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/prevention" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191071">Prevention</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/consumer-protections-enforcement" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192701">Consumer protections & enforcement</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/pre-existing-condition-plan" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191056">Pre-existing condition insurance plan</a> </li> <li class="menu-item menu-item--l3"> <a href="https://www.healthcare.gov/glossary/qualifying-health-coverage" class="menu-item-element" aria-current="false">Qualifying Health Coverage (QHC)</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2"> <span class="menu-item-element" aria-current="false">RG-Placeholder-2</span> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">In-person assisters</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/marketplace/in-person-assisters/information-partners" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2078851">Information for Partners</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/in-person-assisters/outreach-education" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073436">Assister outreach & education</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/in-person-assisters/applications-forms-notices" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073441">Applications, forms, & notices</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/in-person-assisters/programs-procedures" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073446">Assister programs & procedures</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/in-person-assisters/technical-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073231">Assister technical resources</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/in-person-assisters/training-webinars" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073451">Assister training & webinars</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Agents & Brokers</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/marketplace/agents-brokers/resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192876">Resources for Agent & Brokers</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/agents-brokers/registration-training" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1290426">Registration & training</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/agents-brokers/open-enrollment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193226">Open enrollment</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/agents-brokers/direct-enrollment-partners" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1550226">Direct enrollment partners</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/agents-brokers/general-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/185021">General resources</a> </li> <li class="menu-item menu-item--l3"> <a href="https://www.youtube.com/playlist?list=PLaV7m2-zFKpgUK9AqdbnOdW69-WwodvRj" class="menu-item-element" aria-current="false">Video Learning Center</a> </li> <li class="menu-item menu-item--l3"> <a href="https://www.agentbrokerfaq.cms.gov/s/" class="menu-item-element" aria-current="false">Agent & Broker FAQ</a> </li> <li class="menu-item menu-item--l3"> <a href="/files/document/agent/broker-help-desks.pdf" class="menu-item-element" aria-current="false" data-drupal-link-system-path="media/112386">Marketplace help desk & call centers</a> </li> <li class="menu-item menu-item--l3"> <a href="https://data.healthcare.gov/ffm_ab_registration_lists" class="menu-item-element" aria-current="false">Registration Completion List</a> </li> <li class="menu-item menu-item--l3"> <a href="https://data.healthcare.gov/ab-registration-tracker/" class="menu-item-element" aria-current="false">Marketplace Registration Tracker</a> </li> <li class="menu-item menu-item--l3"> <a href="https://data.healthcare.gov/ab-suspension-and-termination-list" class="menu-item-element" aria-current="false">AB Suspension & Termination List</a> </li> <li class="menu-item menu-item--l3"> <a href="https://localhelp.healthcare.gov/" class="menu-item-element" aria-current="false">Find local help</a> </li> <li class="menu-item menu-item--l3"> <a href="https://data.healthcare.gov/issuer-partner-lookup" class="menu-item-element" aria-current="false">Issuer and direct enrollment partner directory</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/agents-brokers/help-on-demand" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193196">Help on demand</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/agents-brokers/shop-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193096">SHOP Resources</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded menu-item--active-trail"> <span class="menu-item-element" aria-current="false">Health Plans & Issuers</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/marketplace/health-plans-issuers/qualified-health-plan-certification" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191371">Qualified health plan certification </a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/health-plans-issuers/summary-benefits-coverage" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191461">Summary of benefits & coverage</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/health-plans-issuers/insurance-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192101">Insurance programs</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/health-plans-issuers/premium-stabilization-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191326">Premium stabilization programs</a> </li> <li class="menu-item menu-item--l3 menu-item--active-trail"> <a href="/marketplace/health-plans-issuers/insurance-market-reforms" class="menu-item-element active-page is-active" aria-current="page" data-drupal-link-system-path="node/191421">Health insurance market reforms</a> <li class="menu-item menu-item--l3"> <a href="/marketplace/health-plans-issuers/minimum-essential-coverage" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192891">Minimum essential coverage</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace-private-insurance/health-plans-issuers/pbm-drug-pricing-review" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2088761">Drug pricing & rebate review</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Employers & sponsors</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="https://www.healthcare.gov/small-businesses/other-coverage" class="menu-item-element" aria-current="false">Coverage</a> </li> <li class="menu-item menu-item--l3"> <a href="https://www.healthcare.gov/small-businesses/choose-and-enroll/shop-marketplace-overview" class="menu-item-element" aria-current="false">Regulation & guidance</a> </li> <li class="menu-item menu-item--l3"> <a href="https://www.healthcare.gov/small-businesses/choose-and-enroll/qualify-for-shop-marketplace" class="menu-item-element" aria-current="false">Small business tax credit & premium assistance</a> </li> <li class="menu-item menu-item--l3"> <a href="https://www.healthcare.gov/small-businesses/choose-and-enroll/appeal-a-shop-decision" class="menu-item-element" aria-current="false">Appeals</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/employers-sponsors/small-business-health-options-program-shop" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192901">Small Business Health Options Program (SHOP)</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/employers-sponsors/early-retiree-reinsurance-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191651">Early retiree reinsurance program</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/employer-initiatives" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192916">Employer initiatives</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">States</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/marketplace/states/state-marketplace-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190916">Planning & establishing a Marketplace</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/states/territory-cooperative-agreements" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190926">Territory cooperative agreements</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/states/early-innovator-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191691">Early innovator program</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/states/state-flexibility-stabilize-market" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193246">State flexibility to stabilize the Market </a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/states/creating-competitive-marketplace" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192231">Exchange establishment grants</a> </li> <li class="menu-item menu-item--l3"> <a href="https://www.healthcare.gov/coverage/pre-existing-conditions" class="menu-item-element" aria-current="false">Pre-existing condition insurance plan</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Resources</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/marketplace/resources/about-us" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192721">About Us</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/resources/data" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191741">Data resources</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/resources/forms-reports-other" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190966">Forms, reports, & other resources</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/resources/letters" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191646">Letters</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/resources/regulations-guidance" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191366">Regulations & Guidance</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/resources/training" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191466">Training resources</a> </li> </ul> </div> </div> </li> </ul> </div> </li> <li class="menu-item menu-item--l1 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Priorities</span> <div class="subnav-wrapper--1 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-main ds-u-lg-display--none">Back to main menu</span> <h2 class="subnav-title-h2" style="position:relative;text-align:left;width:auto;height:auto;">section title h2</h2> </div> <ul class="menu"> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Innovation Center</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/priorities/innovation/overview" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2090631">Overview</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/priorities/innovation/about" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2074091">About</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/priorities/innovation/key-concepts" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072461">Key Concepts</a> </li> <li class="menu-item menu-item--l3"> <a href="/priorities/innovation-center/model-data" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2087691">Model Data</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/priorities/innovation-center/value-based-care-spotlight" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2082926">Value-Based Care Spotlight</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/priorities/innovation/models" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072436">Innovation Models</a> </li> <li class="menu-item menu-item--l3"> <a href="/priorities/innovation/where-innovation-happening" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072451">Where Innovation is Happening</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/priorities/innovation/evaluation-research-reports" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072446">Evaluations & Research Reports</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Health Equity</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/priorities/health-equity/c2c" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1974361">Coverage to Care</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/priorities/health-equity/minority-health" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1620916">Minority health</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/priorities/health-equity/c2c/es" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072591">Cobertura de atención</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/priorities/health-equity/grants-awards" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1612961">Grants & awards</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Recent Legislation</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/inflation-reduction-act-and-medicare" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1621896">Inflation Reduction Act and Medicare</a> </li> <li class="menu-item menu-item--l3"> <a href="/nosurprises" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1573261">No Surprises Act</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Key Initiatives</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/priorities/key-initiatives/opioids" 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data-drupal-link-system-path="node/178211">Employers & unions</a> </li> </ul> </div> </div> </li> </ul> </div> </li> </ul> </nav> </div> </div> </div> </div> </div> <div class="header-breadcrumb-wrapper ds-u-display--none ds-u-md-display--block cms-tracker--breadcrumbs"> <div class="ds-l-container"> <div class="ds-l-row"> <div class="ds-l-col--12 ds-u-display--flex ds-u-justify-content--between ds-u-align-items--center"> <div id="block-cms-evo-breadcrumbs" class="block block-system block-system-breadcrumb-block"> <div class="content"> <span class="create-date"> </span> <nav class="breadcrumb" aria-label="Breadcrumb"> <ul class="menu cms-evo-unstyled-list"> <li> <a href="/" title="CMS Home" class="linked-breadcrumb"><i class="fas fa-home"></i></a> <i class="fas fa-angle-right"></i> </li> <li> Marketplace & Private Insurance <i class="fas fa-angle-right"></i> </li> <li> Health Plans & Issuers <i class="fas fa-angle-right"></i> </li> <li> Health insurance market reforms </li> </ul> </nav> </div> </div> </div> </div> </div> </div> </header> <div id="page-wrapper" class="layout-builder-enabled-view-mode section_page"> <div id="page"> <main id="skipNavTarget" role="main"> <div id="main-wrapper" class="clearfix"> <div class="ds-l-container"> <div class="ds-l-row"> <div class="ds-l-col--12"> <div class="region region-cms-page-menu-block-header"> </div> </div> </div> </div> <div id="main" class="clearfix"> <div> <inner> <div class="ds-l-container"> <div class="ds-l-row"> <div class="ds-l-col--12"> <div class="region region-content"> <div data-drupal-messages-fallback class="hidden"></div> <div id="block-cms-evo-pagetitle" class="block block-core block-page-title-block"> <div class="content"> <span class="create-date"> </span> <h1 class="ds-u-visibility--screen-reader page-title"><span class="field field--name-title field--type-string field--label-visually_hidden">Health Insurance Market Reforms <div class="title-border"></div></span> </h1> <div class="title-border"></div> </div> </div> </div> </div> </div> </div> <div id="block-cms-evo-content" class="block block-system block-system-main-block"> <div class="content"> <span class="create-date"> </span> <div class="node node--type-section-page node--view-mode-full clearfix"> <div class="node__content clearfix"> <div class="subsite_body"> <div class="layout--constrained section--bg-style-none section--bg-color-none layout layout--onecol-section"> <div class="ds-l-container"> <div class="ds-l-row"> <div class="layout__column ds-l-col--12 cms-global-center"> <div class="block block-layout-builder block-field-blocknodesection-pagetitle"> <div class="content"> <span class="create-date"> </span> <span class="field field--name-title field--type-string field--label-visually_hidden alternate-page-title ds-u-margin-bottom--0 ds-u-font-size--3xl ds-u-font-weight--semibold">Health Insurance Market Reforms </span> </div> </div> <div class="block block-layout-builder block-field-blocknodesection-pagebody"> <div class="content"> <span class="create-date"> </span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field__item"><div class="rxbodyfield"> <p>The Affordable Care Act includes a number of provisions that reform the health insurance market. These reforms work to put American consumers back in charge of their health coverage and care, ensuring they receive value for their premium dollars. The law creates a more level playing field by cracking down on unreasonable health insurance premiums and holding insurance companies accountable for unjustified premium increases.</p> <h2><span class="rx_inlinevariant mceNonEditable"> <a title="Annual Limits" data-entity-substitution="canonical" data-entity-type="node" data-entity-uuid="c3349ab1-211d-4c14-9a75-2803e9ba649f" href="/marketplace/private-health-insurance/annual-limits" class="titlelink">Annual Limits</a> </span></h2> <hr> <p>Starting in 2014, the law bans annual dollar limits. This means plans cannot have annual dollar limits on coverage of essential benefits, such as hospital, physician and pharmacy benefits.</p> <h2><span class="rx_inlinevariant mceNonEditable"> <a title="Coverage for Young Adults" data-entity-substitution="canonical" data-entity-type="node" data-entity-uuid="982ac666-a4b5-410a-9ca1-ce9beca5120d" href="/marketplace/private-health-insurance/coverage-young-adults" class="titlelink">Coverage for Young Adults</a> </span></h2> <hr> <p>Under the law, if a plan includes children, a parent can cover children on their health insurance plan until the child turns 26 years old.</p> <h2><span class="rx_inlinevariant mceNonEditable"> <a title="Grandfathered Plans" data-entity-substitution="canonical" data-entity-type="node" data-entity-uuid="1969bc65-050b-4f0b-b131-de3fccab0384" href="/marketplace/private-health-insurance/grandfathered-plans" class="titlelink">Grandfathered Plans</a> </span></h2> <hr> <p>Grandfathered health plans protect the ability of individuals and businesses to keep their current plan, while providing important consumer protections that give Americans control over their own health care.</p> <h2> <a title="Health Reimbursement Arrangements" data-entity-substitution="canonical" data-entity-type="node" data-entity-uuid="4cf44de0-3dbf-4a59-b70d-cca871e0cfe3" href="/marketplace/private-health-insurance/health-reimbursement-arrangements" class="titlelink">Health Reimbursement Arrangements</a>  </h2> <hr> <p>Health reimbursement arrangements (HRAs) are a type of account-based health plan that employers can use to reimburse employees for their medical care expenses.  </p> <h2><a data-entity-substitution="canonical" data-entity-type="node" data-entity-uuid="66177391-484e-468b-be43-08736b801d58" href="/marketplace/private-health-insurance/market-rating-reforms" title="Market Rating Reforms">Market Rating Reforms</a></h2> <hr> <p>These requirements standardize how health insurance issuers can price products, bringing a new level of transparency and fairness to premium pricing.</p> <h2><span class="rx_inlinevariant mceNonEditable"> <a title="Medical Loss Ratio" data-entity-substitution="canonical" data-entity-type="node" data-entity-uuid="d8038da9-dd70-4b68-a75e-631c203c74d5" href="/marketplace/private-health-insurance/medical-loss-ratio" class="titlelink">Medical Loss Ratio</a> </span></h2> <hr> <p>Medical loss ratio (MLR) is the proportion of premium revenues spent on clinical services and quality improvements. The law requires health insurance issuers to submit data on MLR and issue rebates to enrollees if this percentage does not meet minimum standards.</p> <h2> <a title="The Mental Health Parity and Addiction Equity Act (MHPAEA)" data-entity-substitution="canonical" data-entity-type="node" data-entity-uuid="3542ef99-e2a9-4c5d-b0ba-5a90d5017ca6" href="/marketplace/private-health-insurance/mental-health-parity-addiction-equity" class="titlelink">The Mental Health Parity and Addiction Equity Act (MHPAEA)</a>  </h2> <hr> <p>The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits.</p> <h2><a data-entity-substitution="canonical" data-entity-type="node" data-entity-uuid="59ac76c0-5bfc-4454-b176-141b304d02d8" href="/marketplace/health-plans-issuers/minimum-essential-coverage" title="Minimum Essential Coverage">Minimum Essential Coverage</a></h2> <hr> <p>Minimum essential coverage (MEC) is the level of coverage an individual needs to have to meet the individual responsibility requirement under the Affordable Care Act. This includes job-based coverage, individual market policies, Medicare, Medicaid, CHIP, TRICARE, and certain other coverage. Health plans not statutorily specified and not designated through regulation as MEC may apply to HHS to be recognized as MEC.</p> <h2><span class="rx_inlinevariant mceNonEditable"> <a title="Patient's Bill of Rights" data-entity-substitution="canonical" data-entity-type="node" data-entity-uuid="74eb21c9-4b63-4b7f-8ce4-5378381d9c3d" href="/marketplace/private-health-insurance/patient-bill-of-rights" class="titlelink">Patient's Bill of Rights</a> </span></h2> <hr> <p>The Patient’s Bill of Rights helps all Americans with pre-existing conditions gain and keep their coverage, protects all Americans’ choice of doctors, ends lifetime limits on the care consumers may receive and includes other provisions.</p> <h2> <a title="Prevention" data-entity-substitution="canonical" data-entity-type="node" data-entity-uuid="e9c39d76-639f-4328-990e-33cb9b5e3b7a" href="/marketplace/private-health-insurance/prevention" class="titlelink">Prevention</a> </h2> <hr> <p>Prevention regulations require new health plans to cover certain evidence-based preventive services and eliminate cost sharing requirements for these services.</p> <h2><span class="rx_inlinevariant mceNonEditable"> <a title="Review of Insurance Rates" data-entity-substitution="canonical" data-entity-type="node" data-entity-uuid="9d26369c-4b92-4fc7-8f11-aa142c9b2d1a" href="/marketplace/private-health-insurance/review-insurance-rates" class="titlelink">Review of Insurance Rates</a> </span></h2> <hr> <p>Rate review is part of a series of reforms to improve insurer accountability and consumer transparency. Grants will be used to help states crack down on unreasonable health insurance premium hikes.</p> <h2><span class="rx_inlinevariant mceNonEditable"> <a title="Student Health Plans" data-entity-substitution="canonical" data-entity-type="node" data-entity-uuid="2bc98675-dfdc-4e86-a952-eb3e9f14992f" href="/marketplace/private-health-insurance/student-health-plans" class="titlelink">Student Health Plans</a> </span></h2> <hr> <p>Student Health Plans are health insurance plans that are offered to students. These plans are often purchased when family coverage is not available. Some of these plans are comprehensive but other offer limited benefits.</p> <h2><span class="rx_inlinevariant mceNonEditable"> <a title="Self-Funded, Non-Federal Governmental Plans" data-entity-substitution="canonical" data-entity-type="node" data-entity-uuid="72abed2b-e83e-4455-a1b8-17861869afcc" href="/marketplace/private-health-insurance/self-funded-non-federal-governmental-plans" class="titlelink">Self-Funded, Non-Federal Governmental Plans</a> </span></h2> <hr> <p>Prior to enactment of the Affordable Care Act, sponsors of self-funded, non-Federal governmental plans were permitted to elect to exempt those plans from, or “opt out of,” certain provisions of the Public Health Service (PHS) Act. This election was authorized under section 2721(b)(2) of the PHS Act.</p> <p>The Affordable Care Act made a number of changes, with the result that sponsors of self-funded, non-Federal governmental plans can no longer opt out of as many requirements of Title XXVII.</p> <h2><a data-entity-substitution="canonical" data-entity-type="node" data-entity-uuid="337201e7-147b-4916-88d5-46e33a492650" href="/marketplace/private-health-insurance/consumer-protections-enforcement" title="Compliance and Enforcement">Compliance</a></h2> <hr> <p>In order to ensure that all consumers receive protections of the Affordable Care Act, CMS is responsible for enforcing market reforms in states that are not enforcing them directly or have not entered into a collaborative arrangement with CMS on enforcement.</p> <h2>Additional Resources:</h2> <hr> <ul> <li><a href="/cciio/resources/Regulations-and-Guidance/index#Health Market Reforms">Regulations & Guidance</a></li> <li><a href="/cciio/Resources/Fact-Sheets-and-FAQs/index#Health Market Reforms">Fact Sheets & FAQs</a></li> <li><a href="/cciio/Resources/Letters/index#Health Market Reforms">Letters & News Releases</a></li> <li><a href="/cciio/Resources/Funding-Opportunities/index#Health Market Reforms">Funding Opportunities</a></li> <li><a href="/cciio/Resources/Forms-Reports-and-Other-Resources/index#Health Market Reforms">Other Resources</a></li> </ul> </div></div> </div> </div> </div> </div> </div> </div> </div> <div class="layout--onecol-section"> <div class="ds-l-container"> <div class="ds-l-row"> <div class="ds-l-col--12"> <div class="changed-date-block"> <div class="changed-date-decorative-bar" aria-hidden="true"></div> <div class="changed-date"> <div class="field__label">Page Last Modified:</div> <div class="field__item">09/10/2024 06:11 PM</div> </div> <div class="help-link"> <a href="/node/169881" title="Help with File Formats and Plug-Ins" class="file-format-help">Help with File Formats and Plug-Ins</a> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </inner> </div> </div> </div> </main> </div> </div>  <footer class="cms--footer ds-u-padding-y--3 ds-u-lg-padding-y--5 ds-u-margin-top--4"> <div class="ds-l-container"> <div class="ds-l-row ds-u-justify-content--center footer-email-section"> <div class="ds-l-col--12 ds-l-md-col--6 ds-l-lg-col--8"> <h2>Get email updates</h2> <p>Sign up to get the latest information about your choice of CMS topics. 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