New Issue Brief Examines Specialty Drugs in Tiered Pharmacy Benefit Structures

Health plans have been increasingly using tiered pharmacy benefit designs. These new designs raise challenges for consumers and the state insurance regulators responsible for reviewing and approving plans for sale. CHIR faculty members Sally McCarty and David Cusano explore these issues in a new brief for the Robert Wood Johnson Foundation’s State Health Reform Assistance Network.

CHIR Launches First in Video Series: Coffee Conversations on Timely Health Insurance Topics

We at the Center on Health Insurance Reforms are excited to share the first of an upcoming video series on timely health insurance topics. In our debut video, CHIR experts Sabrina Corlette, JoAnn Volk, and Dave Cusano provide a preview of upcoming action at the National Association of Insurance Commissioners’ (NAIC) national meeting to address concerns about network adequacy of health plans offered through the new health insurance Marketplaces.

After Halbig: Considerations for States Revisiting the Option to Establish a State-Based Marketplace

A federal appeals court’s ruling that premium subsidies aren’t available for consumers who purchase health coverage through one of the ACA’s federally run insurance marketplaces could have drastic consequences. But policymakers in the 34 states with a federal marketplace have options for protecting their residents. In one of CHIR’s blogs for the Commonwealth Fund, Kevin Lucia and Justin Giovannelli discuss those options here.

Summing Up Questions from Navigators: A Grab Bag of Consumer Queries

Though open enrollment into the new health insurance marketplaces is a distant memory and folks are gearing up for round 2 later this year, consumers continue to turn to Navigators and other assisters with questions. JoAnn Volk shares – and provides answers to – a selection of questions we’ve been getting from the field.

Decoding 2015 Health Insurance Rate Increase Requests

“The rates are coming, the rates are coming.” The release of 2015 health insurance premium rates provides new fodder for the latest pronouncements on the success or failure of the Affordable Care Act. In a blog post originally published by the Health Affairs blog, Christopher Koller and Sabrina Corlette decode what’s happening with insurers’ 2015 rate requests and why.

New Report Reviews State Action on Quality Improvement in State-Based Marketplaces

The Affordable Care Act envisions that the new health insurance marketplaces will encourage plans to provide better quality, more cost-effective care. But achieving that is easier said than done. A recent report by CHIR faculty Sarah Dash and Sabrina Corlette charts action by the state-based marketplaces to achieve quality improvements and assesses future prospects. Ashley Williams provides an overview.

All Enrollees Should Contact the Marketplace at Renewal

We’re about 110 days away from open enrollment into coverage for 2015. In recent guidance, CMS has revealed its plans for plan renewals and eligibility re-determinations for people enrolled in plans through the marketplaces. Our Georgetown colleague Tricia Brooks takes a look at the envisioned process and some of the benefits – and pitfalls – for consumers.

Grace Periods for Failing to Pay Insurance Premiums: What Consumers Need to Know

On July 16 the Obama Administration published guidance for insurers in the federally facilitated marketplaces (FFMs) regarding a requirement that they provide a 90-day grace period to policyholders who fail to pay premiums. Sabrina Corlette reviews the new rules and offers some advice for consumers who might find themselves in this situation.

ACA Days of Summer

It’s getting to be a summer tradition: a new set of court decisions on the Affordable Care Act. This past week two courts reached opposite conclusions on whether the IRS can issue subsidies through the federally facilitated marketplaces, affecting potentially 7.3 million people. Research Fellow Sandy Ahn talks about these decisions and their impact on the ACA’s ability to address the “three As” of health coverage: access, affordability, and adequacy.

New Report on Key Lessons for LGBT Outreach and Enrollment under the Affordable Care Act

Today, Out2Enroll—a nationwide campaign dedicated to connecting LGBT people with their health insurance coverage options—released a new report exploring the extent to which this year’s outreach and enrollment efforts met the needs of the lesbian, gay, bisexual, and transgender (LGBT) community. Katie Keith provides an overview of the report’s major findings in this guest post.

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.