…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…
…costs incurred, or the net loss, was more than $1.2 billion for all 35 state high-risk pools combined in 2011. As a result, many states had to limit enrollment, impose waiting periods, cut benefits, and charge premiums as much as twice the price of traditional individual market plans. On the eve of the ACA, these pools covered just a fraction…
…aided by unnamed investors from the Maryland healthcare community. The company then had to exit the individual market exchange in December, pending approval from CMS. This resulted in a loss of 10,000 members to competing insurers. Their current 26,000 member population is drawn from the employer group market, with most coming from small businesses. Evergreen executives say that the transition…
…have maintained or enacted standards that exceed the federal minimum. Most states elected to retain their role as the primary regulators of insurance and enforce both federal and state protections.[1] At a minimum, most states continue to ensure that companies have sufficient financial reserves, review proposed premium rate increases, confirm that plans deliver on promised benefits, identify and stop fraudulent…
…of stabilizing the market while covering people with pre-existing conditions, noting that historically, “enrollment has generally been low, coverage has been limited and expensive, they required external funding, and they have typically operated at a loss.” Examining a proposal on the more progressive end of the spectrum, AAA concludes that a public option could hurt market competition and provider participation…
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