…forced to cap or close enrollment in their high risk pools in order to limit losses. And all of them experienced losses, even though they received billions in government subsidies. In 2011, net losses for the 35 state high-risk pools were over $1.2 billion. There is no question that high-risk pools provided a source of coverage to a set of…
By Sabrina Corlette and Jack Hoadley We’re experiencing another round of bad headlines for the Affordable Care Act (ACA) marketplaces. A government report found that, on average, premiums will rise 25 percent and consumers will have fewer insurance company choices in 2017. Eighty-three insurers will stop offering plans through the marketplaces next year while only 16 insurers will enter; 21…
…medical management programs (e.g., asthma, heart disease, low back pain, weight loss or pain management), and insurance companies. Perhaps the most important tool for consumers available again this year will be navigators, assisters, and brokers, who assist consumers looking to enroll or re-enroll into marketplace coverage. As we’ve noted before, these assisters play a key role for consumers wanting to…
…certain income losses or exclusions. Therefore, some tax filers receiving PTCs appear to have incomes below the minimum income levels for PTC. In addition, the report does not provide data on household size or any demographic data related to the PTC or ISRP. (If you want a thorough breakdown of the tax provisions of the ACA before you wade into…
…2014 premium rates. Yet another budget deal in 2014 required the ACA’s risk corridor program to be budget neutral, limiting the amount the federal government could remit to insurers for their losses. As a result, marketplace insurers received only 12 cents on the dollar for 2014. This was a particularly harsh blow for the CO-OPs, which lacked the financial cushion…
…another special enrollment. In this particular situation, loss of marketplace coverage because you failed to submit verifying documents does not trigger a special enrollment due to loss of qualifying coverage or loss of minimum essential coverage. If you do have another life event like you move or get married, then you could apply based on those events for a special…
…the loss of a job, a move, or marriage, to buy a plan outside of the annual enrollment period. So short-term coverage is no longer one of the only ways for people to get transitional coverage. The Administration finds that, post-ACA, insurers have stretched the short-term policy definition beyond recognition. Many people are not only purchasing short-term plans as their…
By Henry J. Aaron*, Kevin Lucia and Justin Giovannelli Health reform (aka Obamacare) is entering a new stage. The recent announcement by United Health Care that it will stop selling insurance to individuals and families through most health insurance exchanges marks the transition. In the next stage, federal and state policy makers must decide how to use broad regulatory powers…
…back to the United States from abroad; and moving to a state that expanded Medicaid and having a change in income making that consumer eligible for financial assistance. The rule also eliminates the requirement that people be allowed to use the moving SEP 60 days in advance of a move and eliminates the SEP for the loss of a dependent…
…we are pleased to see that the final rule better incorporates pediatric providers. For example, the final rule requires states to develop pediatric network adequacy standards for the following classes of providers: primary care, behavioral health (including mental health and substance use disorder), specialists, and dental. Accountability and Transparency: The final rule maintains the minimum medical loss ratio of 85%…
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