The transitional reinsurance program is part of the Patient Protection and Affordable Care Act intended to keep premiums stable by reimbursing payers for high-cost members that incur claims between $45,000 and $250,000.
CMS originally planned to pay insurers a coinsurance rate of 80 percent. However, HHS has collected $8.7 billion in reinsurance contributions from payers for 2014 and expects $1 billion more before Nov. 15, 2015. These contributions have far exceeded requests for repayment, so CMS has adjusted the coinsurance rate to 100 percent. This means payers will be fully reimbursed for “non-grandfathered reinsurance-eligible individual market plans’ covered claims costs” between $45,000 and $250,000.
HHS plans to send payers a report on June 30 with detailed information on the amount it will receive in reinsurance payments for 2014, according to the announcement.
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