How Approved SBM Funding for Enhancing Platforms will Affect Consumers

Ongoing legislation changes continue to effect State-based Marketplaces (SBMs) and how they supply insurance to new and returning members on the Marketplace. On June 21, 2021, the Centers for Medicare and Medicaid Services (CMS) announced it was moving forward with $20 million in grants to SBMs called for under the American Rescue Plan (ARP) – to help states and SBMs adapt to new and upcoming requirements. These upgrades required SBMs to invest time and money for technology changes that will help States adapt to the new requirements outlined in the ARP.

Under President Biden’s ARP, SBMs have been required to make upgrades to eligibility and enrollment processes to account for increased Premium Tax Credit (PTC) subsidies available to consumers. What is more, SBMs had to create special functionality to allow Unemployment Insurance (UI) recipients to receive a high level of assistance called for under the ARP. The approved funding will allow SBMs to make advancements to their current technology in efforts to allow for a smooth integration of these new and future policies.

The question remains on how these grants and the changes that they will fund will affect consumers.

1. An Increase in Affordable Healthcare

Potential funding is primarily designed to help SBMs adapt to changes proposed in the ARP and other recent legislation. States must find a way to seamlessly and efficiently adjust to the changes to advance premium tax credits (APTC) and cost-sharing reductions (CSRs) made by the ARP. This will result in cost savings on quality health plans across the board.

In addition to making this a reality, the funding will also provide assistance and education to enrollees and potential new customers regarding the ARP subsidy changes. Savings are useless if you aren’t aware of them or don’t know how to access them. Both advancements in technology and the way that information is conveyed to members will help Americans gain access to comprehensive health insurance at an affordable price.

2. A User-Friendly Platform

User-experience is becoming a top priority for health insurers and SBMs. These grants will help replace outdated systems that aren’t user friendly. Fast loading times, intuitive sign-up options, and a personalized shopping experience are just some of the things that may be on the horizon. Decision support tools can help you find the plan that suits your needs at a price you can afford.

SBMs are approved to use provided funding to streamline member enrollment and verifications through implementations of enhancement such as Enhanced Direct Enrollment (EDE). EDE allows you to enroll in health coverage though the Federally-facilitated Exchanges (FFE) and SBMs without visiting HealthCare.gov. You can enroll in the same quality health plans through private partners (like W3LL) and complete all steps in the enrollment process on a single website.

Investing in intuitive technology will increased healthcare accessibility as you will no longer have to struggle through outdated interfaces that make shopping for healthcare impossible.

3. Better Communication to Keep Members Up to Date

One area SBMs have significant needs is consumer outreach and education via member communication. This has been an area of concern during the COVID-19 pandemic but has increased in importance as the new ARP subsidies have gone into effect.

Common ways that your SBM might contact you include via email, via snail mail, and through their online portal. The abundance of new legislation and changes to SBMs results in the need for constant notices that keep you up to date and ensures you are ready for new and incoming regulations. SBMs investing in their communication processes ensures you are aware of what is to come.

Different SBMs will see different amounts of funding and have different plans on how to spend it. Improved user interfaces, communication, and overall accessibility might not be on every SBM’s agenda, but it is safe to say that changes made on the highest level will impact the consumer.