CMS issues Program Integrity guidelines for Marketplace

Health care law will provide families an average of $100 back in premium rebates

Today, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule outlining program integrity guidelines for the Health Insurance Marketplace (Marketplace) and premium stabilization programs.

Through the Affordable Care Act, consumers and small businesses will have access to new Marketplaces where they can access quality, affordable private health insurance. Consumers in every state will be able to buy insurance from qualified health plans directly through these Marketplaces and may be eligible for tax credits to lower the cost of their health insurance.   

“In just a few months, consumers across the country will have access to a new Marketplace in their state where they can easily shop for health insurance that meets their needs and the needs of their families,” said CMS Administrator Marilyn Tavenner. “The release of these guidelines signals that we’re ready to build on our ongoing efforts and ensure that the new systems are fiscally sound.”

Many of the provisions in today’s rule build on guidance previously issued to states and other key stakeholders. The policies offer clarity on oversight of various premium stabilization and affordability programs, build on state options regarding the Small Business Health Options Program, and provide technical clarifications.

With open enrollment only a few months away, consumers can look forward to receiving more information in the coming weeks and months about how to enroll in the Marketplace.

This summer, CMS will re-launch, where consumers will have access to real-time information and help to sign up for coverage during open enrollment in October.

The Marketplace call center will begin taking calls from consumers, beginning with educational information and then assisting with enrollment and plan selection on October

1. CMS will also begin consumer assistance training this summer so that consumers will have the help they need in applying for and choosing the coverage that is right for them.

To access the proposed rule released today, visit:

To view a fact sheet on the proposed rule, visit:

For more information about Health Insurance Marketplaces, visit:

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