Search Results for: stop-loss

Affordable Care Act Navigators: Unexpected Success During 2018 Enrollment Season Shouldn’t Obscure Challenges Ahead

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…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…

2018 Outlook: What Health Insurance Experts at CHIR Will be Watching

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…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…

Marketplace Plan Discontinued? Options after Open Enrollment

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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…

New Rules Pending on Short-Term Health Plans: Impacts for Consumers, Markets and Potential State Responses

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…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…

State Options Blog Series: Implications of Weakening the 80-20 Rule for States and Consumers

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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…

When the Individual Market Dies, Where will People Go? A Eulogy

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…market and raise prices. Then, there were the Trump administration’s repeated threats to cut off cost-sharing reduction reimbursements to insurers. Insurers factored the loss of those funds into their 2018 rates, resulting in projected premium increases averaging 20 percent. Insurers also had to price for the real risk that the Trump administration would not enforce the individual mandate or invest…

Shopping Tips for 2018 Open Enrollment

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This year’s open enrollment is different from previous years. First, the time to shop and enroll in a plan is cut in half; open enrollment this year is from November 1 to December 15. Second, the Trump administration’s recent decision to stop repayments for plans with reduced cost-sharing has caused some unexpected consequences for plan premiums and tax credits for…

Insurers, State Regulators Avoid Bare Counties in 2018, but Seek Long-Term Solutions

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…contributor to decreased insurer participation in individual markets. Good longstanding relationships between regulators and the industry were an important foundation for negotiations over filling bare counties. Although an insurer’s decision ultimately needed to align with the company’s business strategy, state actions also helped prevent bare counties through assurance from state regulators of protection from financial losses resulting from unexpected policy…

Proposed 2019 Affordable Care Act Payment Rule: A Big Role for States

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…comes to implementing (or not implementing) the ACA. The proposed rule would defer additional decision making and oversight to state insurance regulators. This blog highlights some of the major decisions that states would be tasked with under the proposed rule, including in the areas of essential health benefits, qualified health plan (QHP) certification standards, rate review, medical loss ratio (MLR)…

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.