By Joan Alker, Georgetown Center for Children and Families Having concrete policy ideas may not be in vogue on the campaign trail, but here at Georgetown’s Center for Children and Families (CCF) we are grateful to have the opportunity and challenge to think deeply about the future of health coverage for children and families. Today we are launching a new…
…complaints comprised 52 percent of all submitted complaints. These were: Denials of claims (18%) Quality of care (11%) Medical necessity denials (10%) Co-pay, deductible, or co-insurance issues (7%) Enrollment or disenrollment issues (6%) Other complaints related to policy cancellations, eligibility determinations, and coverage. Of the Covered California complaints, 85 percent focused on a denial of eligibility for the marketplace, 13…
…they have under the Affordable Care Act (ACA) to stabilize, expand, and diversify risk pools, improve local market competition, encourage insurers to compete on product quality rather than premium alone, and promote effective risk management. In addition, insurance companies must master rate setting, plan design, and network management, and effectively manage the health risk of their enrollees in order to…
By Sandy Ahn and Sabrina Corlette Open enrollment this year will bring a variety of changes for the federally facilitated marketplaces (FFMs). Officials will be implementing new renewal policies and improving ways to communicate with and display plans to consumers. The administration has made these policy changes for 2017 in an effort to ensure not just a better shopping experience,…
…even before the ACA). We also completed analyses based on different ACA-related state policies. We compared marketplace type – state-based or federal – and found that take-up rates of tax credits for coverage were almost twice as high among states running their own marketplaces. We also compared states based on their Medicaid expansion status – early expanders (2011-2013), 2014 expanders,…
The administration recently issued a new rule tightening the special enrollment periods (SEP) for the individual insurance market. In doing so, the Centers for Medicare and Medicaid Services (CMS), which administers the ACA’s health insurance marketplaces, is responding to reports from insurers that some consumers who did not sign up during open enrollment are taking advantage of SEPs when they…
…has been repeated ad nauseam over the last several years, with Republican members raising a litany of complaints about the ACA and Democrats on the committee highlighting the law’s numerous accomplishments. However, the tone was more civil than many past hearings, with a number of members expressing interest in moving past the rancor and identifying areas of potential common ground….
…their plans to address the discriminatory practices. The complaint with OCR is still pending. Other states have taken action, as well. For example, Montana’s insurance commissioner, in responding to a complaint from the National Multiple Sclerosis Society regarding discriminatory cost-sharing for specialty tier drugs, used her form review authority to require insurers to offer at least one plan with co-pays…
…remain and target training and educational resources more appropriately for the next open enrollment season. During a three-month enrollment period (November 2015—January 2016), the federal marketplace’s Assister Help Resource Center (AHRC) fielded nearly 1,400 calls pertaining to complex application filings for health insurance, eligibility determinations, and enrollment scenarios. Here are a few things we learned: Determining whether someone is eligible…
By Alisa Chester, Georgetown University Center for Children and Families In the U.S., 15.7% of mothers are uninsured. That’s 5.9 million mothers or one out of every six , according to new study from the Urban Institute. We care about all parents but with Mother’s Day right around the corner, we are focusing on moms for now. In How Are…
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.
