Search Results for: stop-loss

How Could a New Administration Tackle Affordable Care Act Challenges? Look to Medicare

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…

What to Expect When You’re Enrolling: A Preview of Open Enrollment Season 4

…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…

State Legislators Conduct Post-Mortem on Affordable Care Act CO-OPs and Plot Next Steps

…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…

New Special Enrollment Confirmation Process Effective June 17, 2016: What it Means for Consumers

…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…

You Don’t Know Who You Are Dealing With: Unscrupulous Broker Tries to Sell Us Short-Term Health Insurance

…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…

The Next Stage in Health Reform

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…

Major New Rule Seeks to Modernize & Improve Quality of Medicaid Managed Care

…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%…

NAIC Roundup: Catching Up on the Spring Meeting and Looking Ahead

…the different SEPs that are available (for example, due to a permanent move rather than loss of other coverage). However, that data is not available in the report, nor is there data to show reasons enrollees allow coverage to lapse (for example, because an enrollee obtained other coverage). My fellow consumer representative, Sarah Lueck, offered a consumer perspective on SEPs,…

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.