The ACA requires coverage of recommended preventive services without cost-sharing for consumers enrolled in most private health plans. But even with these protections in place, some insurers improperly impose cost sharing for preventive services. Recently, this problem hit consumers who use pre-exposure prophylaxis (PrEP), a medication that can prevent contraction of HIV.
Under the Affordable Care Act, insurers must provide rebates to enrollees when their spending on clinical services and quality improvement, as a proportion of premium dollars, falls below a minimum threshold. Federal regulators have discovered some insurers are gaming the system by misallocating expenses or inflating their spending on providers. Karen Davenport takes a look at how this practice impacts consumers, and explains a new federal proposal to crack down on it.
In our newest monthly roundup of health policy research, CHIR’s Emma Walsh-Alker reviews studies on the potential of personalized phone outreach to boost marketplace enrollment, trends in the small-group health insurance market, and the Congressional Budget Office’s latest report comparing how much commercial insurers and Medicare pay for health services.
The Affordable Care Act’s health insurance marketplaces and consumer protections significantly improved the experience of purchasing individual health insurance, but consumers still face the difficult task of comparing a potentially overwhelming number of complicated benefit and network designs. A proposal in the Notice of Benefits and Payment Parameters for 2023 may improve this situation. Karen Davenport takes a look at the possible return of standardized plans to the federal marketplace, and what this change might mean for consumers.
Private health plans are now required to cover at-home over-the-counter COVID-19 tests. CHIR’s Megan Houston and Rachel Swindle reviewed the coverage policies of 51 insurers to see how consumers can access this benefit. They found a number of plans with restrictions that go beyond what federal guidelines allow.
We’re delighted to welcome to the CHIR team our two newest colleagues, Research Fellow Jalisa Clark, M.P.H., and Research Associate Emma Walsh-Alker.
This month, we’re ringing in the new year with new health policy research. In our final roundup of 2021 publications, CHIR’s Emma Walsh-Alker reviewed analyses about the impact of the ACA’s Medicaid expansion on coverage status and access to maternal care, how the Build Back Better Act would change health insurance for low-income individuals and families, and consumer choice in health care.
As of January 15th, the open enrollment period has ended in most states. A record number of consumers signed up for 2022 marketplace coverage. So what comes next for marketplace enrollees? First, give yourself a pat on the back for enrolling in health coverage! Second, consult CHIR’s Navigator Resource Guide for expert answers to FAQs about post-enrollment issues you may face, like unexpected coverage denials and balance bills.
January can feel like a time for new beginnings, and new year’s resolutions. In recent years, many employers have provided workplace wellness programs that may help employees stick with these resolutions, such as benefits, services, or financial incentives that encourage workers to improve their health. Recent data from KFF’s 2021 Employer Health Benefit Survey showing that employers are reconsidering key elements of their wellness initiatives prompted CHIR to take a look at some of the changes—and ongoing issues—with workplace wellness programs.
As we enter 2022, consumers are now protected from many of the worst surprise medical bills. The No Surprises Act, enacted with bipartisan support, took effect on January 1. CHIR’s JoAnn Volk describes the new protections, and what patients should keep in mind if they receive care from out-of-network providers and hospitals.
The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.
