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Stakeholder Perspectives on CMS’s 2025 Notice of Benefit and Payment Parameters: Health Insurers and Brokers

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…Note on Our Methodology This blog is intended to provide a summary of comments submitted by insurance companies, representative associations, and brokers. This is not intended to be a comprehensive review of all comments on every provision in the proposed 2025 NBPP, nor does it capture every component of the reviewed comments. To view more stakeholder comments, please visit https://www.regulations.gov/….

Policy Innovations in the Affordable Care Act Marketplaces

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…comprehensive health insurance. In a recent issue brief for the Commonwealth Fund, CHIR experts reviewed policy decisions by state-run Marketplaces and the federally facilitated Marketplace, including efforts to reduce enrollment barriers, simplify plan choice, promote market competition, and increase health equity. The authors also created an interactive map dashboard highlighting even more key Marketplace policies for the 2023 plan year….

Looking Under the Hood: “Enhanced” Rate Review to Improve Affordability

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…in the provider market has given health systems considerable market power. Absent meaningful competition in these markets, some states are turning to regulatory options to keep prices in check. One of these regulatory options is an enhanced form of premium rate review, in which regulators are empowered to review whether the provider prices that compose such a large proportion of…

Navigator Guide FAQs of the Week: Post-Enrollment Issues

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…emergency care or an out-of-network provider at an in-network facility. If you went out-of-network because you felt it was medically necessary to receive care from a specific professional or facility—for example, if you felt your plan’s network didn’t include providers able to provide the care you need—you can appeal the insurer’s decision. If you inadvertently got out-of-network care while at…

Proposed Rule Would Roll Back Expansion Of Association Health Plans

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The U.S. Department of Labor (DOL) has released a proposed rule that would rescind a Trump-era regulation designed to expand the formation and use of Association Health Plans (AHPs). DOL is also seeking comment on whether to formalize, through rulemaking, pre-existing criteria for the formation of a “bona fide” employee welfare benefit plan. Comments on this proposed rule are due 60 days…

A Wolf in Sheep’s Clothing: The Pitfalls of Treating Telehealth Coverage as an “Excepted Benefit”

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…excepted benefit products together, so that they appear on the surface like a comprehensive policy, without clearly communicating that these arrangements do not comply with key consumer protections and leave enrollees at significant financial risk. Fourth, a standalone telehealth benefit that an employee can choose in lieu of a major medical plan could disproportionately harm lower income workers. These workers…

Step-by-Step: Congressional Proposals Could Help Unlock Information Key to Curbing U.S. Health Care Spending

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…Billing Practices Obscure the Impact of a Major Outpatient Spending Driver One component of the recent explosion in spending on outpatient care are “facility fees”—the fees hospitals and health systems charge for outpatient visits to hospital-owned sites of care. As hospitals have created vertically integrated health care systems by acquiring outpatient delivery sites, facility fee charges have proliferated. Facility fees…

Navigator Guide FAQs of the Week: Wrapping Up Open Enrollment

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…your premium payments directly to the health insurance company. Once you’ve selected your plan, the Marketplace will direct you to your insurance company’s website to make the initial premium payment. Insurance companies must accept different forms of payment and they cannot discriminate against consumers who do not have credit cards or bank accounts. The insurance company must receive and process…

Implementing the No Surprises Act: What We Know from Early Complaint Data

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…contains costs. Release of complaint data offers promising but limited insights on NSA Implementation Compared to the rate of care utilization, relatively few complaints have been filed: in the first 22 months since implementation, CMS reported only 7,888 complaints that deal specifically with NSA compliance. For comparison, two trade groups representing insurers estimate that one million claims are submitted each…

Proposed 2025 Payment Rule: Marketplace Standards And Insurance Reforms

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…accessible, toll-free call center that can respond to consumers’ requests for assistance. Once an SBM is established, HHS monitors call center operations through annual data reports that document call volume, wait times, abandonment rates, and average call handle time. While HHS declines at this time to set minimum staffing levels for Marketplace call centers, they are proposing that SBMs meet…

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.