Understanding Federal Guidance on Reference Pricing: A New Primer from Georgetown’s Center on Health Insurance Reforms

Implementing the ACA

Some employer health plans have begun to respond to dramatic differences in the cost of medical procedures through reference pricing. CHIR’s Kayla Connor shares a new primer prepared for the Robert Wood Johnson Foundation’s State Health Reform Assistance Network that helps insurance regulators understand the latest federal rules on reference pricing and potential consumer protection issues. Continue reading

Coverage that Falls Outside Affordable Care Act Protections: A Primer on “Excepted Benefits” and Short Term Health Insurance

Implementing the ACA

As consumers shop for health insurance, many may be offered coverage, such as “excepted benefit” plans or short-term, limited duration policies that fall outside of the protections required in the Affordable Care Act. CHIR’s Kayla Connor shares a primer on these policies, published by the Robert Wood Johnson Foundation’s State Health Reform Assistance Network. Continue reading

Regulatory Activity in Two States Restricts How Plans Structure Specialty Drug Coverage

State of the States

Two state insurance regulators, Florida and Montana, have taken recent regulatory action to address concerns raised by advocacy groups about the way specialty drugs are covered in pharmacy benefit plans offered in their states. Sally McCarty provides details of those actions and related updates on the oversight of discriminatory benefit designs. Continue reading

Insurance Premium Surcharges for Smokers May Jeopardize Access to Coverage

State of the States

While the ACA limits the power of insurance companies to charge higher prices to consumers based on health status and other factors, the law doesn’t stop insurers from imposing a premium surcharge on tobacco users that can raise the cost of coverage by as much as 50 percent. In a new blog post for the Commonwealth Fund, CHIR researchers discuss the pros and cons of tobacco rating and examine why some states have chosen to ban the practice. Continue reading

The First Tax Filing Season under the Affordable Care Act is Approaching: What Do Marketplace Consumers Need to Know?


The 2014 tax season will be the first time tax filers will have to report on their health insurance coverage. Marketplace consumers, particularly those receiving premium tax credits, will need to take a few more steps when completing their 2014 taxes. Sandy Ahn provides a short summary of tax forms that marketplace consumers will be using. Continue reading

The Affordable Care Act’s Requirements for Quality Improvement in the Health Insurance Marketplaces: What Recent Federal Action Tells Us

Implementing the ACA

The Affordable Care Act sets out several requirements for the health insurance marketplaces to encourage insurers to improve quality and deliver better value coverage. Implementation of these provisions has been slowed by the focus on other, more urgent operational priorities, but recent federal rules put plans on notice that quality improvement standards, reporting requirements, and rankings are soon coming their way. Sabrina Corlette has this overview. Continue reading

Marketplace Coverage Renewals: Variation in State Approaches May Affect Consumers’ Finances

State of the States

Auto-renewal through the health insurance marketplaces is an important mechanism for consumers to avoid a gap in coverage, but variations in state and federal approaches could impact consumers’ premiums and tax credits. In their latest blog post for the Commonwealth Fund, CHIR experts compare the renewal processes chosen by 17 state-based marketplaces and assess their impact on consumers’ finances. Continue reading