By Kevin Lucia and Sabrina Corlette A recent Washington Post article calls association health plans (AHPs) “promising” and asserts that AHPs are “consumer friendly,” offer “generous benefits,” and have “lower prices” than Affordable Care Act (ACA) plans. It appears to have been largely informed by an organization called associationhealthplans.com, which was set up to promote AHPs. A more balanced analysis…
…Act (ACA). STLDI tends to have lower premiums than ACA coverage, but depending on how it is marketed and sold, can be risky for consumers. Many buy these plans mistakenly believing that they are as comprehensive as traditional, ACA-compliant plans. A growing market for STLDI plans also places new demands on state insurance departments, which are responsible for overseeing insurers…
…if only the brand name product is medically appropriate. HHS asks for comment on whether this policy should preempt any state laws that could conflict with its application. They further seek comment on whether an insurer’s decision regarding the exclusion of a drug from EHB should be considered an adverse benefit determination that would trigger an enrollee’s right to appeal….
…medical bills from health providers outside their insurance plan’s network after receiving emergency care or medical procedures at in-network facilities. While a federal solution could offer a more comprehensive approach to protecting consumers, it is important to note that several states have taken action to protect consumers from balance billing. In their latest 50-state review for The Commonwealth Fund’s To…
…they fared in this year’s Open Enrollment, and the challenges ahead. Community partnerships are vital to get consumers in the door. Navigator were unanimous: establishing themselves as community partners was imperative to their success. Because these programs have been beneficial to many community organizations, partners were quick to help get the word out and direct consumers who needed coverage to…
…lost subsidies due to a failure to file or reconcile a past year’s tax return. Because healthcare.gov call center staff are not allowed to discuss confidential tax information with consumers, they typically refer people in this situation to the IRS. During the shutdown, although that agency is recalling some employees to work without pay, it could still be short on…
…Resource Guide. Here are a few common queries: I have a $2,000 deductible but I don’t understand how it works. Can I not get any care covered until I meet that amount? A deductible is the amount you have to pay for services out-of-pocket before your health insurance kicks in and starts paying for covered services. Under the Affordable Care…
…an Affordable Care Act-compliant individual health insurance policy. This reduces the risk that employees will self-sort themselves according to health status, with healthy employees gravitating to low-cost underwritten products (like short-term plans), and sicker workers opting for the guaranteed issue, community-rated ACA-compliant market. However, the proposal’s preamble suggests that the final policy could weaken or eliminate these safeguards. Matthew Fiedler…
…insured bear the biggest brunt of this upward pressure on prices, including the over 150 million Americans covered under their employer’s health plan. Commercial rates for hospital services are on average 89 percent higher than what Medicare pays for the exact same service, as much as 500 percent higher in some markets. The result is that family premiums for commercial,…
…be reversed on appeal. However, as the case wends its way through the courts, the companies who provide and deliver health care services are faced with the prospect of market chaos and upheaval if the judge’s ruling is allowed to stand. More importantly, the millions of consumers and patients who have come to rely on the ACA’s protections could lose…
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