…insurance because, in his words, “I know all my patients and none of them would ever sue me.” We did take the solo practitioner in a town where the local factory that employed most of his patients would be offering our plan, even though he called me a Communist after I explained how capitation worked. Don’t get me wrong. There…
…on people with certain health conditions, such as those who need mental health services. For example, fewer and fewer psychiatrists are taking insurance. A recent study found that only 55 percent of psychiatrists accept private insurance, compared with 89 percent of other doctors. With high retail costs for commonly prescribed psychiatric drugs, (e.g. upwards of $1,000 a month for Abilify,…
…better understand this guidance. (1) Jane Smith tried to enroll in coverage on December 14, 2013 but could not complete enrollment because the website crashed. She’s been uninsured since January 1, 2014 and is not able to complete a successful enrollment into a QHP until March 14, 2014. If Jane’s Marketplace implements the policy outlined in the guidance, both the…
By Sonya Schwartz, Georgetown University Center for Children and Families Arkansas Governor Beebe recently noted that some Republican Governors are warming to the idea of running their own health insurance marketplace. I hope that they know that their time is running out! Setting up a state-based health insurance marketplace is no small task, and unlike the Medicaid expansion decision, states…
By Justin Giovannelli, Kevin Lucia, and Sabrina Corlette The Affordable Care Act requires each of the new health insurance marketplaces to conduct consumer outreach and enrollment assistance through a “navigator” program. In earlier posts for The Commonwealth Fund blog, CHIR reported that many states that decided not to develop their own marketplaces—leaving that task to the federal government—have acted to…
By David Cusano and Amy Thomas The ACA’s new essential health benefits and metal tier coverage standards, guaranteed issue, and community rating requirements help level the playing field among insurers in terms of their ability to compete on cost in the individual and small group markets. Therefore, insurers are turning to limited network products as a way to leverage more…
…good actuary knows, are more likely to incur higher health care costs, although the degree to which gender-based rate differences could be actuarially justified has been subject to debate. The latest enrollment data from the health insurance marketplaces show that women have been more likely to enroll, by a margin of 55 to 45 percent. Hence the hand-wringing about whether…
…Center on Health Insurance Reforms’ “Implementing the ACA Project” and was generously supported by The Commonwealth Fund. The views presented here are those of the author(s) and not necessarily those of The Commonwealth Fund or its directors, officers, or staff. Editor’s Note: Ms. Monahan is a former Senior Research Analyst at the Center on Health Insurance Reforms. She is currently…
By Martha Heberlein, Georgetown University Center for Children and Families Updated 2014 federal poverty thresholds were released on January 22nd and inquiring minds have been asking what they mean in terms of determining eligibility for Medicaid, CHIP, and premium tax credits. And the answer, as with so many things in our world is, “well, it depends.” Let’s start with premium…
The Center for Consumer Information and Insurance Oversight (CCIIO) has released an update for insurers and consumers on new healthcare.gov functionality to allow consumers to report life changes, qualify for a special enrollment period, and switch plans. For consumers, and those charged with assisting them, there are some helpful changes. Below are a couple top takeaways. Improved IT functionality for…
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