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

MEC and MV: Keeping it All Straight When it Comes to Employer Plans

Implementing the ACA

Open enrollment in the Health Insurance Marketplaces overlaps this year with many employer plan open enrollment periods, which has prompted some employees to ask questions about how their offer of employer coverage may affect their eligibility for premium tax credits. CHIR’s JoAnn Volk and Sandy Ahn take a look at what consumers need to know, especially if they’re offered a plan that doesn’t offer much coverage. Continue reading

Embedded Deductibles: Source of Consumer Confusion

Implementing the ACA

Understanding how health insurance works can be confusing, particularly when it comes to deductibles, a topic we’ve had a lot of questions about. In today’s post, Sandy Ahn discusses how an embedded deductible works in a health plan for family coverage and compares that to an aggregate deductible. This information is also included in our online Navigator Resource Guide released last month. Continue reading

Renewing Coverage under the ACA: Challenges and Opportunities for Federally Facilitated and State-based Marketplaces

Implementing the ACA

December 15th marks the last day by which health insurance marketplace enrollees can actively renew their plans for January 1st start dates. If they take no action, many will be auto-renewed. In a new report, CHIR experts Sabrina Corlette, Jack Hoadley and Sandy Ahn examine the renewal process and share their findings in CHIR’s latest web video. Continue reading