…so consumers can benefit from a real one-stop-shopping experience and don’t need to click back and forth between different websites. It’s also important to remember that the effectiveness of any of these tools is only as good as their inputs. As we discussed in our December 2013 report for the Commonwealth Fund, a number of state-based marketplaces have taken steps…
…after September 24, 2014. I pay more for my plan because I’m a smoker. If I stop smoking after I sign up, will my rates go down? Your insurer doesn’t have to lower your rates to reflect your new non-smoker status until you renew your coverage. I got a letter saying my employer plan didn’t meet the medical loss ratio…
…and Insurance Oversight (CCIIO) recently proposed giving insurers relief on the ACA’s medical loss ratio (MLR) requirement, I didn’t have strong objections. The MLR requirement, often called the 80/20 rule, is a provision of the ACA limiting how much premium revenue an insurer can devote to profits and administrative costs (20 percent in the individual and small employer markets and…
…a drug used to treat depression) many patients would be forced to stop treatment. Does the ACA allow for such an outcome? It appears that it may. Per the EHB rule, individual and small group plans must cover at least the greater of one drug in every U.S. Pharmacopeia category and class or the same number of prescription drugs in…
…or more cancer diagnoses than average. Risk corridors (or risk sharing) involve creation of a fund so that plans with unusually high gains pay back some of those gains and those with unusually high losses are partially compensated. These measures have been in use for Part D for nine years. So how has this system worked in that program? The…
…plans will meet minimum standards for benefits and cost-sharing – no more swiss cheese coverage. State and Federal Regulators Should Make Sure Consumers Get the Right Information – and Act to Stop Any Illegal Cherry Picking State insurance departments have the primary responsibility to ensure that insurance companies are not targeting sicker enrollees for cancellations. They can also provide guidance…
This blog originally appeared as a column in the Indianapolis Business Journal and is re-printed here in its entirety. Battles over the Affordable Care Act have raged since President Obama signed it into law in March 2010—and it’s time they stop. As of this writing, open enrollment for plans offered through the federal Marketplace, the site available to people in…
…Children’s Health Insurance Program—through the marketplace. Achieving the vision for marketplaces as a seamless one-stop shop for obtaining coverage will largely depend on new IT systems that operationalize numerous policy and logistical decisions, provide real-time eligibility assessments, enroll people in appropriate coverage, and ensure premiums are paid correctly. Getting these systems right—under very tight deadlines—is an enormous task. Like all…
…a sicker risk pool – and the higher claims costs for insurers. Because it’s too late in the year for insurers to recalculate and re-file their premium rates for review, they could be exposed to significant losses and it could even threaten their solvency. The bottom line? An attempt to delay the individual mandate is tantamount to an attempt to…
…job. Her doctor told her she should stop working permanently because of the severity of her symptoms. But Karen was hoping to put off that day, and worked as long as she could before taking a second short-term disability leave. It was during that time that she came to terms with the difficult reality of her condition. MS is a…
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.
