Search Results for: stop-loss

Stakeholders Respond to the Proposed Short-term, Limited Duration Insurance Rule. Part III: State Insurance Departments and Marketplaces

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…selling STLDI can deny enrollment to people with pre-existing conditions and exclude from coverage essential health benefits like prescription drugs, maternity, and mental health treatment services. Also, unlike ACA-compliant policies, short-term plans are not subject to the medical loss ratio or risk adjustment, so they are not obligated to spend a certain amount of premium dollars on medical care, and…

May Research Round Up: What We’re Reading

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…Fund completes a national survey each year to track coverage gains and losses across the country. What it Finds 4 million working-age people (ages 19-64) lost coverage between 2016 and 2018, bringing the uninsured rate from 12.7 percent to 15.5 percent. Coverage losses are greatest among those below 250 percent of the federal poverty level (FPL), rising from 20.9 percent…

Stakeholders Respond to the Proposed Short-Term, Limited-Duration Insurance Rule. Part II: Major Medical Insurers

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…those conditions, including essential health benefits like prescription drugs and maternity care. Unlike ACA-compliant policies, short-term plans are not subject to the medical loss ratio or risk adjustment, so insurers are not obligated to spend a certain amount of premium dollars on medical care, and they have no incentive to cover individuals with high-cost conditions. The Obama Administration limited the…

Stakeholders Respond to the Proposed Short-Term, Limited Duration Insurance Rule. Part I: Consumer Advocates

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…health insurance literacy, who will flock to the cheaper plans despite their lack of financial protections. In addition to these risks, ACS-CAN cautioned that short-term plans are exempt from medical loss ratio (MLR) requirements, allowing insurers to spend fewer premium dollars on medical claims. They argue that expanding these products would lead to higher profit margins for insurers at the…

The Effects of Federal Policy: What Early Premium Rate Filings Can Tell Us About the Future of the Affordable Care Act

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…services) and increased utilization; The increase in the overall sickness of the risk pool due to ACA-related policy changes that lead to the loss of young and healthy enrollees; Whether the insurer expects to be a payor or a payee under the ACA’s risk adjustment program; Changes in benefit plan designs; Changes in service areas; Changes in the impact of…

The Urban Institute’s New Proposal to Get Us Closer to Universal Coverage

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…capped at 8.5% of household income. Other components of the Urban Institute’s proposal include: Eliminating the employer mandate penalty along with the “firewall” that stops individuals with employer offers of insurance from buying on the new Healthy America market. Cost-sharing reductions would be increased, extending deductible and cost-sharing assistance to those earning up to 300 percent of the FPL (up…

States Leaning In: Washington

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…a stop-gap measure for 2019, the bill would enable residents who live in bare counties to purchase state-subsidized coverage through Washington’s high-risk pool. However, Premera Blue Cross has pledged to participate in the marketplace in any county that lacks another insurer, so the high-risk pool option is unlikely to be needed. Protecting Markets from Plans That Don’t Comply with the…

A Vacation in Germany: What’s Health Insurance Like Here?

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In Germany, when the “Ampel Mann,” or traffic man, is red, the culture is to stop and wait. When I studied in Berlin in 2014, I did not realize this until I crossed the street and an older woman chastised me, “Den Kindern ein Vorbild!” (Be a role model for the children!). So, what happens if someone ignores the Ampel…

March Research Round Up: What We’re Reading

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…analysis looks at past, present, and future challenges for employer-sponsored health insurance (ESI), and considers the point at which employers may cease offering subsidized health coverage to their employees. What it Finds The “tipping point” for ESI will be when employers face significant financial losses that cannot be passed on to employees through higher premiums, and that are not outweighed…

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