Review Tool FAQs

Cost Sharing Tool

Q1: How should an issuer resolve a “Not Met” error when running the Cost Sharing Tool under the expanded bronze plan review?

  • Plans often fail the expanded bronze plan review because the copay values in the Instructions tab of the Cost Sharing Tool are not updated by the user. The values are all set to $0 by default, and meaningful results will not be produced if these values are not changed.

    The Cost Sharing Tool is set up to allow states to set their own benchmarks for "reasonable cost sharing" on the major service being covered before the deductible. CMS states in the HHS Notice of Benefit and Payment Parameters for 2023 that we recognize that states are the primary enforcers of AV policy. CMS also recognizes that services vary in costs by region and that issuers need flexibility in plan design. 

    However, at a minimum, any cost-sharing rate for an expanded bronze plan that requires the enrollee to pay for more than 50 percent of the coinsurance (or the equivalent copay rate) could be considered an unreasonable cost-sharing rate for the major service before the deductible. Therefore, an issuer should input a copay value into the table on step 4d of the Instructions tab in order to accurately run the review for their state.