…because of the amount of health care the enrollee had used the previous year. HIPAA stopped that practice, requiring insurers to renew individual policies except in certain limited conditions (i.e., the entire product line is discontinued, or the enrollee doesn’t pay premiums or moves outside the plan’s service area). The HIPAA guaranteed renewability protection applies to health insurance issuers, and…
…mental health parity to the Medical Loss Ratio (MLR). This new round of grants, the State Flexibility to Stabilize the Market Grant Program, will fund more state-based initiatives in three key areas of market reforms and consumer protections: guaranteed issue, guaranteed renewability, and the ACA’s Essential Health Benefits (EHB). Guaranteed Issue and Guaranteed Renewability Under the ACA, insurers are required…
…enrollees receive payments from those insurers with a relatively low share of high-risk enrollees. Yes Not clear**** Medical loss-ratio standard Limits how much premium revenue an insurer can devote to profits and administrative costs (20 percent in the individual market) compared to what they spend on patient care and quality improvement. Yes Not clear**** *State-based plans may impose a pre-existing…
…that would waive the prior coverage requirement for certain SEPs if the individual lived in a services area without any QHPs. While no states had “bare counties” in 2018, organizations such as AARP and NHeLP endorsed this proposal as a necessary consumer protection. Many of the organizations also favored HHS’ proposal to create a loss of coverage SEP for women…
…enrollment. But there were losses, too. Organizations in states with vast rural areas like Georgia, Wisconsin, and Montana had to cut back on the number of counties they could serve. In other states, like New Jersey and Virginia, prioritizing low income communities meant less outreach to higher-income communities that have concentrations of eligible uninsured people. The organizations we spoke to…
…how will insurers respond to the loss of the individual mandate penalty – will we see insurers dropping out when it comes time to decide whether to participate in the individual market in 2019? Third, I’m keeping an eye on what happens with birth control coverage. Do employers and schools decide to drop coverage under the Trump administration’s religious or…
Blink and you may have missed it. Open enrollment for HealthCare.gov was much shorter this year and ended on December 15, 2017.* Individuals with discontinued health plans, however, may still be able to enroll in a marketplace or off-marketplace plan through a special enrollment period. Not having coverage because of a discontinued health plan is a loss of minimum essential…
…in 2018 and 2019. But states have already had to make decisions regarding the 2018 plan year: in the face of repeated threats by the administration to stop paying for CSRs, most states required (or encouraged) insurers to assume the payments would cease and instructed them to add the CSR shortfall onto the premium rates for silver plans (usually, only…
…coverage; and require nonrenewable short-term coverage to be discontinued at the end of the calendar year. Allowing the sale of short-term coverage but reducing the risk of market segmentation. State policymakers could assess insurers that offer short-term coverage; require short-term policies to meet a minimum medical loss ratio; and require consumers to have a marketplace eligibility determination before an insurer…
The Trump Administration recently issued a proposed regulation that could have significant implications for consumers on a number of fronts, including how much of their premium is actually spent by insurers on their health care needs. The ACA requires insurers to meet a minimum medical loss ratio (MLR). The MLR, often called the “80/20 Rule,” measures how much a health…
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.
