…the organizations that filed the complaint within 30 days of executing the agreements to discuss access and affordability issues as well as prescription drug assistance programs. In a January letter to the OCR, the organizations that filed the Florida complaint asked the Office to rule on the complaint even though three of the four insurers have settled. Their request is…
By Justin Giovannelli, Kevin Lucia, and Sabrina Corlette Prior to the Affordable Care Act, insurance companies in most states could charge two people a different price for the same health coverage, depending on their medical history, gender, or occupation, among other reasons. The ACA reformed these premium rating practices by limiting the factors that insurers are allowed to consider when…
…considered MEC, individuals with marketplace coverage receiving or claiming premium tax credits will need to take a few more steps. Consumers with marketplace coverage getting or claiming premium tax credits will need to complete Form 8962 as part of their tax filings. Consumers will use Form 8962 to reconcile the amounts of tax credits they received (based on projected income)…
…the policy side, but we also need more data to focus our efforts! There are many ways to improve outreach and enrollment to individuals eligible for coverage who live in immigrant families, I’ve written about them in many of my previous blog posts. But, in addition to these fixes, we also need timely and more specific data to help us…
…but surely – implementing the quality improvement requirements prescribed by the ACA. In their latest rules and guidance, the FFM puts insurance companies on notice that quality improvement standards, reporting requirements and rankings are coming their way. Quality Improvement Strategy The ACA requires plans participating on the marketplaces to maintain a “quality improvement strategy” designed to prevent hospital readmissions, improve…
…liability. In our latest blog post for the Commonwealth Fund, we surveyed 17 state-based marketplaces about their approaches to coverage renewals and found that a number of them took advantage of the flexibility provided under federal rules to reduce consumers’ potential financial risk. Others, largely because of changes to their IT systems, required enrollees to return to the marketplace to…
…federal poverty levels). Many cost-sharing plans have low or even zero deductibles, or exempt certain services from the deductible to meet the cost sharing requirements. If the cost-sharing reductions bring the deductible below the deductible requirement under a HDHP (i.e., a HSA-compatible plan), you’ll no longer be eligible for an HSA because you don’t have a compliant health plan (i.e.,…
…Johnson Foundation, CHIR faculty and a colleague at Georgetown’s Center for Children and Families help Navigators answer some of their more complicated consumer questions, including questions about employer-based coverage. Recently, one consumer asked how a plan that didn’t include coverage for hospitalization could meet the Affordable Care Act’s minimum essential coverage (MEC) standard. Yet the plan materials said it was,…
…total family deductible must be paid out-of-pocket before health insurance starts paying for the health care services incurred by any family member. Let’s take a look at the graphic below (inspired by a similar slide from the Center on Budget and Policy Priorities) comparing how an embedded and aggregate deductible work with the Gomez family. Under an aggregate deductible, none…
On December 1 the Center for Consumer Information and Insurance Oversight (CCIIO) published guidance for insurers on the re-enrollment process for the federally facilitated health insurance marketplace (FFM). While the target audience is those running insurance company operations, the guidance contains some useful information for Navigators and others working to help consumers through the re-enrollment process. Below are a few…
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