Search Results for: stop-loss

Translating Coverage into Care: Answers to Common Post-Enrollment Questions

…1-800-318-2596 (TTY: 1-855-889-4325) as soon as possible to terminate your coverage and if applicable, stop receipt of any premium tax credits. You should also contact your health insurance company to ensure your health plan is terminated. Make sure to document the dates of your contacts with the marketplace and the insurer. Recent federal guidance allows insurers to extend the grace…

Texas Court Ruling Throws Future of ACA’s Pre-existing Condition Protections, Coverage Gains into Doubt

…space for new mothers to pump breast milk. The judge’s ruling does not stop the government from carrying out the law, and the Trump administration announced over the weekend that they would continue to do so. Further, legal experts on both sides of the political spectrum argue the judge’s decision is on shaky legal ground and predict that it will…

October Research Round Up: What We’re Reading

…the 2017 policy changes. What It Finds Medical Loss Ratios (MLR), or the percentage of premiums insurers spend on medical claims, saw continued improvement mid- 2018, down to an average of?? 69 percent as compared to a peak of 93 percent in 2015, indicating an increase in insurer profitability. When measuring performance of an insurer by gross margins, or by…

States Lean In as the Federal Government Cuts Back: Navigator and Advertising Funding for the ACA’s Sixth Open Enrollment

By Sabrina Corlette and Rachel Schwab On November 1, the Affordable Care Act’s (ACA) insurance marketplaces will launch their sixth enrollment season. This year, the challenges they face may be greater than laster year, with the loss of the individual mandate penalty as an enrollment incentive and the emergence of a parallel, unregulated market that could siphon away healthy enrollees….

What’s New for 2019 Marketplace Enrollment? Get Ready for Updated, Improved Navigator Resource Guide

…eligible for a SEP in the 60 days prior to loss of CHIP coverage until 60 days after the loss of CHIP coverage. Proposed Public Charge Rule: The Department of Homeland Security released a proposed rule that would broaden the types of public benefits that would count against an immigrant’s application for admission to the U.S. or permanent residency to…

Proposed “Public Charge” Rule Risks Immigrants’ Access to Private Coverage, Too

…these hard working families access to health coverage is good public policy. Even DHS itself admits that the proposed rule could increase poverty, and that immigrants who don’t enroll in benefits for which they’re eligible could experience a loss in productivity, adverse health effects, higher medical expenses, and reduced educational attainment. Comments on the rule are due December 10, 2018….

Lawmakers had a Chance to Provide Relief from Surprise Medical Bills – and Whiffed It

…ambulance providers clearly disclose charges for transportation and non-transportation services and “provide other consumer protections for customers of air ambulance operators.” While this provision would not have given states the clear authority to step in and stop egregious balance billing, it would have required a clear separation of medical and transport charges, with the potential that states could regulate the…

House Farm Bill Supports AHPs with Federal Grants—Following in the Footsteps of the ACA’s CO-OP Program

…In its first year, the CO-OPs attracted 500,000 enrollees and almost immediately began to lose money. By the end of their first year, the CO-OPs had aggregate losses of $376 million, and by the end of 2015, half of the plans had shut down. Today, only four of the CO-OPs remain. Among other funding and political considerations, the CO-OPs struggled…

Massive Navigator Funding Cuts Pose Risks for Consumers, Marketplaces

…is all but setting up these organizations for failure because they will not be able to enroll a “meaningful amount” of consumers with fewer resources, and won’t have the capacity to take on added consumers as brokers stop serving the individual market. For example, I volunteer as a certified application counselor in Northern Virginia. Up to this point, there have…

When Policy and Politics Conflict: Challenges to State-level Market Stabilization Efforts

…risk of paying claims, with a stop-loss policy that protects the employer from unexpectedly high claims costs. However, although these arrangements can be affordable and attractive to small employers with young and healthy employees, they carry significant risk. If someone in the group gets sick, the employer can face significant rate hikes, unexpected claims liability, and even lose eligibility for…

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.