…include: An uncertainty that the cost sharing reduction subsidies (CSRs), which reduce out of pocket expenses for eligible enrollees, will be honored.Corlette says that a loss of subsidies could be a factor in significant premium increases for those who purchase insurance on their own. The potential lack of IRS enforcement of the individual mandate, an additional tax that must be…
…review rates in the absence of a decision on the fate of CSR funding. Insurers are on the hook under the ACA to lower cost-sharing for eligible individuals as a condition of participating in the marketplaces, whether they’re reimbursed with federal funds or not. A mid-year loss of CSR funding might prompt issuers to leave the marketplaces rather than absorb…
…enforcement of the individual mandate, arguing that it would encourage broad participation in the markets, particularly among younger and healthier consumers. States also pointed out that enforcing the mandate would be the most effective means of “promoting continuous coverage” and stabilizing the marketplaces. Alaska and Wisconsin also suggested modifications to the medical loss ratio (MLR) rules to allow insurers to…
…“grandfathered” plans, plans that predated the ACA and do not have to comply with many of the law’s reforms. “Level funded” products marketed to healthier groups. Insurers have ramped up the marketing of level-funded products that combine self-funding, a stop-loss policy, and administrative services. These products are targeted to small employers that have relatively young and healthy workers. They are…
…out people with pre-existing conditions and do not have to cover EHB. These plans would then become more attractive to healthy people, and they could charge significantly lower premiums than ACA-compliant plans. This would, in turn, given insurers an incentive to stop offering ACA-compliant plans and leave consumers with pre-existing conditions or who need more comprehensive coverage with fewer options…
On July 18, Unitedhealthcare reported its second quarter (Q2) financial earnings, kicking off the Q2 cycle in which health insurers will announce their quarterly results, detail major financial gains and losses, and provide insight into how they expect to perform over the following quarter. While the audience for these reports is mainly financial analysts, and calls are carefully scripted to…
…a consumer tries to enroll in a plan through a SEP, he or she will be required to verify the life event that qualified them for the SEP. The rules also tighten eligibility for SEPs for certain common qualifying events such as loss of minimum essential coverage and marriage. Additionally, marketplace enrollees that qualify for a SEP now have a…
…enforcement of the law’s individual mandate, recent regulatory actions reduce federal oversight of marketplace health plans, passing responsibility to the states for ensuring compliance with federal consumer protections. In mid-April, the Trump administration announced it would stop monitoring marketplace plans for compliance with several important federal protections and instead defer to state oversight. The administration’s hands-off approach effectively: Rolls back…
By Emily Curran, Justin Giovannelli, Kevin Lucia and Sabrina Corlette Health insurers suffered early financial losses on their Affordable Care Act (ACA) marketplace business last year, leading many to scale back participation and increase premiums for 2017. Though analysts saw evidence of stability after these adjustments, recent federal efforts to repeal and replace the ACA have sparked growing concerns about…
…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…
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