Search Results for: stop-loss

Amid Market Uncertainty, Trump Administration Retreats from Health Plan Oversight

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…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…

Signs of Marketplace Stability May Be Undercut by Federal Policy Uncertainty

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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…

Lots of Changes for 2018 Marketplace Enrollment Mean Confusion for Consumers

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…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…

The Ins and Outs of the New Approach to Special Enrollment Periods: Pre-enrollment Verification (SEPV)

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…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…

We Read Actuarial Memoranda so You Don’t Have to: Trends from Early Health Plan Rate Filings

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…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…

Relaxing the Affordable Care Act’s Guaranteed Issue Protection: Issues for Consumers and State Options

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…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…

Mother’s Day Menu from Congress and the American Health Care Act

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…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…

Court Dismisses Blue Cross and Blue Shield of North Carolina’s Risk Corridor Lawsuit—What About the Other Risk Cases?

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…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…

Loss of Cost-Sharing Reductions in the ACA Marketplace: Impact on Consumers and Insurer Participation

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…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…

Proposed Pre-Verification Process for Special Enrollment Periods: Policy Goals, Potential Impact, and the need for State Flexibility

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…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…

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.