…Marketplace enrollees stop paying health plan premiums and drop their coverage. Many do so either because they cannot afford the premiums or because they obtain other coverage but neglect to notify the marketplace or insurer of that fact. This year, if these individuals come back and try to enroll during OE, their insurer can require them to pay any past-due…
…will apply to new Marketplace applicants experiencing any of the following four events: loss of qualifying coverage or minimum essential coverage (MEC); a permanent move; marriage; gaining a dependent (i.e., adoption, foster care or court order of child support/other court order); and a Medicaid or CHIP denial. The SEPV process will be implemented in phases: applying to consumers losing MEC…
…and insurers. We took a dive into the actuarial memoranda that support each premium rate proposal, and learned the following: Cost-sharing reductions are a big deal Insurers are estimating that the loss of cost-sharing reduction (CSR) payments will drive between 14 and 20 percent of premium increases going into 2018. Blue Cross Blue Shield of North Carolina’s filing calls it…
…insurer so no consumer is shut out of coverage for non-payment of premium for prior coverage. Require insurers to provide exemptions to this policy for extenuating circumstances like temporary job loss, unexpected financial loss, or if a consumer simply transitioned to another form of coverage. Require insurers to establish installment plans for individuals with past-due premiums and only apply the…
…marketplaces, AHCA eliminates the cost sharing subsidies that provide you with a better health insurance plan. Your deductible, annual maximum, copays and coinsurance could increase significantly. If you have a higher income, you are still likely to see higher deductibles if you get covered through the individual market. Dessert Loss of Your Child’s Health Coverage Just to make the meal…
…exchange market for 2014, 2015, and 2016, wherein qualified health plan (QHP) losses and profits that surpassed a certain target would be shared. Insurers with higher than expected profits would pay into the program, while those with heavy losses would collect reimbursements from the fund. However, 2014 and 2015 marketplace losses outpaced the profits paid in, and in the Fall…
…federal subsidies to reduce cost-sharing for low-income enrollees. The Trump administration has the authority to stop federal payments to insurance companies that fund cost-sharing reductions (CSRs), which reduce the burden of things like copayments and deductibles for eligible consumers. Pulling the plug on these federal payments would force carriers to foot the bill, which could throw the individual market into…
…common qualifying events (loss of qualifying coverage, permanent move, birth, adoption or court order, and marriage) or other events the marketplace deems necessary after enrolling through SEP. If documentation not received within 30 days of notice, marketplace to terminate coverage at the end of the month. Note that a pre-verification proposal is currently out for public comment to adopt. District…
…compete in underserved markets, such as by relaxing network adequacy standards, supporting the use of telemedicine for some services, or offering temporary relief from the medical loss ratio requirement if an insurer had an unexpectedly bad year. Other thoughtful analyses of the ACA’s individual markets, and prescriptions for improvement, are discussed in briefs by the Commonwealth Fund, the Urban Institute,…
…stop-loss insurance, which many employers that self-fund their health plans purchase to protect themselves against claims above a specified threshold (called an “attachment point”). The goal here is to make it easier for employers to self-fund their plans and limit the ability of federal regulators to claim that stop-loss insurance with a low attachment point is de facto health insurance…
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.
