…Type 1 diabetes was not on my radar screen. But you don’t know what can come around the corner,” she said. Keeping Veronica healthy and avoiding the serious complications of the disease is something they live with every day. While Nikki feels secure for now, she realizes that they could lose their current health care coverage just like anyone else….
…These plans would not have to meet the “guaranteed issue” requirements of other exchange plans, because they would only be open to those leaving Medicaid and CHIP. However, these plans would allow people to stay with the same provider network they had when they were eligible for Medicaid. In other exchange news, HHS last week released a “Request for Comment”…
…status. Insurers must offer plans with a comprehensive set of essential health benefits. Tax credits will help reduce premiums for low- and moderate-income individuals and families. Medicaid expansion, in some states, will provide coverage for those with the lowest incomes. When the Murphys left New York in 2007, they bought COBRA continuation coverage through Joe’s union plan. It was comprehensive…
…consumers and businesses in their states, in many cases exceeding federal requirements or moving ahead of federal timelines to do so. States also employed innovative strategies to tackle common challenges like encouraging plan participation, mitigating adverse selection, and maximizing enrollment. For example: Many states moved ahead with quality data reporting for health plans on their exchanges. Nine states—California, Colorado, Connecticut,…
…the proposed approach of allowing MSP issuers to use the state’s benchmark package or one of three federal benchmark packages. The comments also noted that variation between MSPs and non- MSPs could complicate plan comparisons on the exchanges. And, because states can prohibit or limit substitution of benefits, the NAIC recommended that MSP issuers also be subject to these state…
In our most recent issue brief for the Commonwealth Fund, we turn to state implementation of the Affordable Care Act’s most significant reforms and regulators’ ability to enforce these new protections. The issue brief is part of an ongoing series by CHIR on implementation of the Affordable Care Act in all 50 states and the District of Columbia. (Learn more…
…requirement that multi-state plan issuers comply with state laws, would mean that multi-state issuers must comply with state “any willing provider” laws. OPM notes that it multi-state plan issuers will need to comply with state form and rate review laws. Nonetheless, if OPM does not agree with a state’s determination, OPM acknowledges that “state approval of a policy form is…
…URAC as a proxy for network adequacy. Over time, CMS intends to monitor network adequacy through complaint tracking. The agency also reserves the right to “gather network data from any QHP issuer at any time” to determine whether the network meets federal standards. Essential community providers The ACA requires QHPs to include “essential community providers” (ECPs) in their networks. These…
…“apples to apples” comparisons among their health plan options, streamlining and simplifying their shopping experience. To fulfill that promise requires some standardization of benefit design, so that consumers can effectively compare such elements as deductibles, co-payments for doctor and emergency room visits, hospital stays, and prescription drugs. This was the experience within the Massachusetts Health Connector, as the state moved…
…in 24 different states, from Arizona to Wisconsin. A full list of the plans is available here. They include such organizations as the Colorado Health Insurance Cooperative, an initiative sponsored by the Rocky Mountain Farmers Union Educational and Charitable Foundation and the Maine Primary Care Association, made up of the state’s community health centers. Other CO-OPs, such as the Montana…
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