…use direct enrollment will use a Marketplace application, but may not have a HealthCare.gov account because the IT system doesn’t automatically generate one for consumers who use direct enrollment. For consumers, this means they may not receive notices or communications from the Marketplace about a data matching inconsistency or other important updates affecting their eligibility and enrollment. This could not…
…treated by a provider who is out-of-network in a network facility. In these situations, the consumer may be faced with an unexpected balance bill for an amount beyond what the insurer paid. Balance billing occurs when a consumer who is treated by an out-of-network provider is subsequently billed by that provider for the difference between what their health plan paid…
…moderate copays: doctor’s visits for non-preventive primary care, specialty care, mental health and substance use disorder; urgent care; and generic prescription drugs in the most popular level of coverage. The researchers also conducted in-depth interviews with key stakeholders such as marketplace officials, state regulators, insurance company representatives, and consumer advocates in four of these states (California, Connecticut, D.C. and Massachusetts),…
…and platinum) beginning with plans that will be available during open enrollment for 2018 coverage. The ACA requires insurers to offer plans in standard levels of coverage based on actuarial value, so that consumers can more easily compare plans on an apples-to-apples basis. However, insurers can meet the actuarial value standards for each metal level with de minimis variation, which…
…from ACA-compliant coverage. This makes the marketplace risk pools sicker, which in turn could drive more insurer exits and higher premiums. To be sure, many U.S. counties face the grim prospect of having no willing insurer in their ACA marketplaces come 2018. This is a result of the uncertainty created by Congressional ACA repeal efforts, an unwillingness of the Trump…
…exist for people undergoing life changes. As we blogged about before, SEP awareness and use are low compared to the millions of people who lose their job-based coverage and move annually, many of whom are young and healthy. Also unclear is whether the administration will be tracking and making available data on how many consumers start but do not complete…
…“the primary driver” of their requested 22.9 percent rate hike. While Anthem’s HealthKeepers plan in Virginia submitted a rate request that assumes CSRs will continue to be paid in 2018, that company’s filing cautions: “A lack of CSR funding introduces a level of volatility which compromises the ability to set rates responsibly. It has been estimated that lack of CSR…
…administration interpreted this ACA provision to prohibit insurers from denying new coverage to individuals who owed premiums for previous coverage and were subsequently terminated for non-payment.* The Trump administration’s new interpretation allows insurers (including a parent company and its subsidiaries) to require an individual to pay past-due premiums owed for coverage in the previous 12 months before enrolling them into…
…season and provide adequate assistance to consumers seeking to enroll in the health insurance marketplaces The U.S. Congress will enact legislation to repeal and replace all or parts of the ACA. In their latest blog post for The Commonwealth Fund, Sabrina Corlette and Kevin Lucia examine what this policy uncertainty means for the tight schedule required to submit, review and…
By Dania Palanker, Sandy Ahn and Sabrina Corlette The United States has an opioid epidemic, with an unprecedented number of opioid-related deaths in recent years. The rise in opioid addiction and overdose is further complicated by the need to effectively treat the approximately 100 million people living with chronic pain. As more people have health insurance than ever before, commercial…
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