CMS Rule Sets Waiver for Some Coverage Under Health Insurance Exchanges

The Centers for Medicare and Medicaid Services plans to soon publish a final rule establishing a waiver process to enable states to offer one or more standard “basic” health insurance plans for individuals, in lieu of offering such individuals coverage through an online state insurance exchange.


The Centers for Medicare and Medicaid Services plans to soon publish a final rule establishing a waiver process to enable states to offer one or more standard “basic” health insurance plans for individuals, in lieu of offering such individuals coverage through an online state insurance exchange.

CMS has sent the rule to the Office of Management and Budget for review, which is one of the last steps before publication. Under the rule, states could offer a standard plan for individuals if the degree of coverage and affordability are comparable to what could be offered through an exchange, if protections against excessive out-of-pocket spending are implemented, and if the standard plan or plans do not increase the federal deficit.