…claims costs grew and premiums, which are partially based on year-to-year claims experience, gradually increased. Those policyholders who remained healthy and could purchase less expensive coverage elsewhere have moved on, while those, like you, whom no other insurer wants to cover, are stuck. And, your insurer stopped selling your policy when premiums got too high to be marketable, which has…
…individual mandate penalty. New SEP for COBRA enrollees Federal rules allow individuals eligible for COBRA coverage to gain a special enrollment period when (1) they first become eligible because of a loss of employer coverage and (2) when their COBRA coverage is exhausted. But, as we document in Frequently Asked Question #166 of our Navigator Resource Guide, if you take…
…access to their treating providers. Others might need to use COBRA to maintain coverage through a job-based plan so they can avoid any gap in coverage, even a small one. The opportunity to trigger a SEP 60 days prior to the loss of coverage will help those who know a loss of coverage is coming. But not everyone will have…
…the SEP is granted. SEP for Survivors of Domestic Violence – married individuals who have experienced domestic violence may also receive a limited circumstance SEP until May 31st. Qualifying life event SEP – people who have specific changes in circumstances such as the birth of a child or the loss of other minimum essential coverage may qualify for an SEP…
…include essential community providers. Standard health plans that are insurer based (and not health maintenance organization or provider network based), also have to meet an 85 percent medical loss ratio standard. What’s next? We’ll continue to watch Minnesota and New York and report back on how their Basic Health Programs are taking shape. We’ll also be on the lookout for…
…changes: First, they must apply for coverage under Medicaid, knowing they won’t be found eligible. Second, upon receiving their denial from the state Medicaid agency, they must apply for a hardship exemption. Third, once their income changes, they must notify the Marketplace, and apply for a special enrollment period based on the loss of their hardship exemption. Needless to say,…
…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…
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