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Insurers will still be allowed to "silver load" on the individual market next year, the Trump administration announced yesterday.
Why it matters: Silver loading was insurers' solution to the administration's decision to cancel the Affordable Care Act's cost-sharing subsidies for low-income enrollees. It essentially keeps insurers from losing money without raising the financial contribution from subsidized enrollees.
The backdrop: There'd been concern that the administration would ban the practice, and it asked for comments on the change, but "it's good news for consumers that the Administration is not implementing" it, Avalere's Chris Sloan said.
- The administration also declined to end automatic re-enrollment, which was estimated to lead to lower enrollment and higher premiums.
What else: The administration's rule does allow insurers to use "copay accumulators," which exclude drug manufacturer cost-sharing assistance from counting toward patients' out-of-pocket maximums.
Yes, but: This cost-sharing assistance wouldn't be counted when a patient is taking a branded drug for which its generic is available, which is "likely to drive higher generic utilization," Sloan said.
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