…eligibility after one year of failing to reconcile APTC—a year in advance of APTC loss. While most commenters supported the proposal, some expressed concern about SBMs’ capacity to send notices of FTR status that comply with federal tax privacy laws. Some requested additional guidance about the content of notices and technical assistance to develop notices and support enrollees. Others expressed…
…87 percent applied actuarial value of a Marketplace plans. In another example, a Texas consumer who believed he was enrolled in a comprehensive insurance policy received a $67,000 hospital bill after a heart attack. In fact, he had a fixed indemnity policy that provided a cash benefit of less than $200 per day of hospitalization. According to NAIC data, the medical loss…
…coverage is the underlying and rising cost of care. Unfortunately, experience suggests that expanding HSAs will not tackle this problem or meaningfully expand coverage. The loss of federal revenue associated with HSAs’ regressive tax cuts could thwart policies that expand health care access for people with the greatest need—those who are currently least likely to have access to affordable coverage…
…be charged) and bars health care providers from collecting more than the insurer-contracted facility fee rate when consumers have not met their deductible. More narrowly, health care providers in Colorado will be prohibited from balance billing consumers for facility fee charges for preventive services provided in an outpatient setting beginning July 1, 2024. 5. Prohibitions on Outpatient Facility Fees: Stopping…
…diagnosis, treatment, and follow-up care (including supplies, appliances and devices).” Both the ADA and the CDA also recommended a required dental loss ratio (often referred to as a DLR), similar to a medical loss ratio (MLR), to ensure dental plans spend a minimum share of premium dollars on dental care rather than administrative costs and profits. Other comments, however, asked…
…in Marketplace coverage. Special enrollment periods When consumers enroll on the FFM through a special enrollment period (SEP)—a mid-year enrollment opportunity triggered by the loss of coverage or another “qualifying life event”—coverage starts at the beginning of the month immediately following the enrollment date. Currently, some SBMs delay coverage effective dates if enrollment occurs in the latter half of the…
…to require that transitioning states document how they would make up for enrollment losses, if they decline to use the Enhanced Direct Enrollment (EDE) functionality that now drives much of HealthCare.gov’s enrollment. Network Standards Health insurance companies were less welcoming of proposals to raise the bar for Marketplace plans by extending the federal Marketplace’s network adequacy standards to insurers participating…
…continue to be considered EHB, and there would be no defrayal requirement. HHS argues that this change will make the identification of benefits in addition to EHB “more intuitive.” The agency acknowledges that there are states that may have been defraying the costs of benefits under the current policy that would be able to stop if this proposal is finalized….
…financial assistance will be key to protecting coverage gains. Looking ahead, policymakers will need to consider an extension of the Inflation Reduction Act’s enhanced Marketplace subsidies to avoid significant coverage losses after plan year 2025. Rebecca Silliman, Erin McNally, Cruz Vargas-Sullivan, and David Schleifer, Searching for In-network Mental Health Care with Marketplace Insurance, Public Agenda. Between October 11–November 14, 2022,…
…in bronze or gold plans. While modeling suggests that resulting coverage losses would be small, this concern has prompted Oregon to consider ways to mitigate the higher premiums for affected enrollees. State Fiscal Impacts The cost of a BHP to the state depends in part on the generosity of the coverage provided. But the cost also depends on how the…
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