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Quality Over Quantity? New Medicaid Network Adequacy Rules Illuminate Disparities Among Insurance Program Standards

…to provider directories). Plans can change provider networks at any time. Sources: Center for Children and Families, Medicaid/CHIP Managed Care Regulations: Network Adequacy and Access to Services, 2016; Kaiser Family Foundation, Comparison of Consumer Protections in Three Health Insurance Markets: Medicare Advantage, Qualified Health Plans and Medicaid Managed Care Organizations, 2015 So what do these differences mean for consumers? Quantitative…

Future of Children’s Health Coverage Series Brief #2: Rethinking Pediatric Dental Coverage

By Colin Reusch, Children’s Dental Health Project and Joan Alker, Georgetown University Center for Children & Families Last month, a U.S. Senator called children’s dental health “a huge issue people simply don’t think about very often.” At Georgetown University’s Center for Children and Families and the Children’s Dental Health Project, we think it is time to change that. Failure to…

Want to Know Whether Your Health Plan’s Network is Narrow or Broad? You’ll Need to Wait Another Year

…Organization) – are no longer accurate indicators of a plan’s network size as insurers continue to reduce their number of contracted providers. As outlined in the administration’s 2017 Letter to Issuers in February of this year, each health plan on healthcare.gov would receive a designation to indicate the plan’s relative network breadth. Plans would be compared to one another within…

A “Volatile Marketplace”: Second Quarter Earnings Calls Offer Glimpse of How Insurers Are Faring on ACA Marketplaces—and What 2017 Might Bring

…us better understand some of the trends affecting the marketplaces’ stability, including insurer exits from some health insurance marketplaces and increases in 2017 premiums. A detailed summary of our review can be found on the Commonwealth Fund’s To the Point site. To learn more about what insurers are reporting about their marketplace experience and business strategies for 2017, click here….

New Report Recommends Policies to Promote Access to Affordable Prescription Drugs

…of Insurance Commissioner’s (NAIC) national meeting, the consumer representatives to the NAIC released a report on state and federal regulatory options for promoting access to prescription drugs.The report, Promoting Access to Affordable Prescription Drugs: Policy Analysis and Consumer Recommendations for State Policymakers, Consumer Advocates, and Health Care Stakeholders, provides a series of recommendations to assist regulators, lawmakers, and the NAIC…

As Administration Reviews Comments on Short-Term Insurance Plans, Analysis Finds Gaps in Coverage

…Office of Insurance Commissioner submitted comments strongly supporting the proposed restrictions on short-term policies. In addition, the DC Health Benefit Exchange Authority, which oversees the District of Columbia’s Health Insurance Marketplace, submitted a letter in support of the proposed changes, noting that Exchange staff has worked with consumers who believed they were enrolled in comprehensive coverage but actually had insufficient…

Stabilizing the Affordable Care Act Marketplaces: Lessons from Medicare

…– through private market mechanisms. And in Medicare and the ACA, a combination of financing, risk stabilization and enrollment outreach strategies are critical to long-term stability. None of the policies or strategies discussed in our paper provides a “silver bullet” solution for the ACA marketplaces, but with modifications or in combination with other strategies some could help private insurers compete…

The Proposed Update to the Premium Tax Credit Safe Harbor: A Solution in Search of a Problem?

…shouldn’t have qualified for, based on year-end income, and possibly money back! Along comes a proposed tweak from the Treasury Department. In a proposed rule (open for comment until September 6th), an individual “who, with intentional or reckless disregard for the facts, provides incorrect information to an Exchange for the year of coverage” — information which the individual knows to…

New Commonwealth Fund Brief Examines Exclusions in Health Insurance Plans that Place Women’s Health at Risk

Do consumers know what is excluded from their health insurance plan? Health insurance plans often include long lists of excluded services. These lists of excluded services carve out various services such as acupuncture or treatment of injuries arising from an act of war. A recent issue brief, published by the Commonwealth Fund and written by Dania Palanker and Karen Davenport…

Wisconsin’s Objection to Automatic Re-enrollment of Enrollees in Federally Facilitated Marketplaces

…longer be offering plans next year. What does this mean? With the news this past spring that UnitedHealthcare is pulling out of most of its ACA marketplaces, and other companies are exiting or reducing their service areas, the Obama administration proposed a policy to help prevent affected consumers from facing a gap in coverage. The administration’s proposal automatically re-enrolls consumers…

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.