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ACA Section 1557 as a Tool for Anti-racist Health Care

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…racial justice. Examples include: Identifying benefit and network designs that discriminate based on race; Imposing affirmative obligations on covered entities (such as ensuring that algorithms are not biased or discriminatory); Requiring the collection and reporting of demographic data; Taking targeted enforcement action; and Conducting a compliance review initiative focused on maternal health disparities. You can read the full piece here….

Navigator Guide FAQs of the Week: Will My Plan Deliver the Care I Need?

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…formulary. A prescription look up tool is also available on HealthCare.gov for consumers to determine whether or not a health plan covers a prescription drug. I am interested in making sure my plan includes a provider who is culturally competent. Do provider networks list the race/ethnicity of the provider or their experience with certain communities? Provider directories do not have…

Consumers Have More Time to Shop for a 2022 Health Insurance Plan

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…weeks of open enrollment, almost 4.6 million people signed up for marketplace plans, and nearly twice as many consumers are getting a plan for $10 or less compared to enrollees at this time last year. The American Rescue Plan (ARP), which temporarily expanded the availability and amount of financial assistance for marketplace enrollees, has made coverage more affordable than ever;…

November Research Roundup: What We’re Reading

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…This study compares the operational structures of air ambulances owned by private equity or publicly traded companies with air ambulances owned by hospitals, nonprofits, and independent companies. What it Finds Air ambulance transports provided by private equity or publicly traded companies averaged a standardized allowed amount (the maximum amount a plan will pay for a service) of $32,051 for 2016…

Navigator Guide FAQs of the Week: What Does My Marketplace Plan Cover?

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Enrolling in coverage on the marketplace requires consumers to compare different health plans and decide which one best fits their needs for the upcoming year. To avoid unwelcome surprises, it’s crucial that consumers have an accurate understanding of what plans will and will not cover before making a final selection. Luckily, resources are available to assist individuals and families in…

Encouraging Signs for the Public Option in Washington State: Improved Availability and Affordability of Plans in 2022

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By: Madeline O’Brien This open enrollment period, Washington State residents can once again purchase first-in-the-nation “public option style” plans, with more options and more affordable premiums than in the program’s freshman year. In their first year, Washington’s publicly procured plans, touted as a mechanism to improve affordability and competition in the marketplace, were less available and more expensive than proponents…

Navigator Guide FAQs of the Week: What Are the Risks of Buying Off-Marketplace?

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…avoid insurance scams, consider CHIR expert Dania Palanker’s advice and be wary of Google search results. Even searching for terms like “Obamacare” can lead consumers away from ACA-compliant insurance and down a rabbit hole of “junk plans.” Consumers should also beware of red flags such as pressure to provide a credit card number right away or an insurance broker refusing…

The State of COVID-19 Testing Coverage and Accessibility

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…provider office, urgent care facility or emergency room. However, coding challenges can make it difficult for an insurer to know if the primary source of the visit was a COVID-19 test. If this happens with an out-of-network provider, a patient’s out-of-pocket costs may be even higher. Hospital testing sites can also be a common source of surprise bills for COVID-19…

Build Back Better Act Clears Major Hurdle

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…behind when their states refused to expand Medicaid. Experts from Georgetown University’s Center for Children and Families and Center on Health Insurance Reforms teamed up to summarize the Medicaid, CHIP, and private coverage provisions of the budget reconciliation bill, including policies to: Provide 12 months of postpartum Medicaid coverage and 12 months of continuous coverage for children; Make federal funding…

Navigator Guide FAQs of the Week: Who is Eligible for Financial Assistance on the Marketplace?

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…cost-sharing that would otherwise apply to covered services. The cost-sharing reductions are available through modified versions of silver plans that are offered on the marketplace. These plans will have lower deductibles, co-pays, coinsurance and out-of-pocket limits compared to regular silver plans. Once the marketplace determines you are eligible for cost-sharing reductions, you will be able to select one of these…

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.