Search Results for: stop-loss

CBO Projections Are Not Destiny: Policies, ACA Investments Can Change Trajectory

Posted by

…by 2034. The agency identifies several factors driving the increase in our uninsured rate, in particular: The Medicaid “Unwind”: States resumed eligibility redeterminations for Medicaid and the Children’s Health Insurance Program (CHIP) in 2023, after pandemic-related continuous coverage requirements expired. Between 2023 and 2024, the CBO projects that this will result in a loss of 13 million people from Medicaid and CHIP,…

State Efforts To Improve Price Transparency

Posted by

…example, Virginia now requires hospitals to comply with the federal hospital price transparency rules, and Indiana requires hospitals to continue complying with federal hospital price transparency rules even if the federal rules get repealed or the federal government stops enforcing them. Minnesota requires not just hospitals but also other providers such as outpatient surgical centers, large imaging and laboratory service providers, and large dental service providers…

Final 2025 Payment Notice: Marketplace Standards And Insurance Reforms

Posted by

…eligibility after one year of failing to reconcile APTC—a year in advance of APTC loss. While most commenters supported the proposal, some expressed concern about SBMs’ capacity to send notices of FTR status that comply with federal tax privacy laws. Some requested additional guidance about the content of notices and technical assistance to develop notices and support enrollees. Others expressed…

Biden Administration Finalizes Limits On Junk Health Plans

Posted by

…87 percent applied actuarial value of a Marketplace plans. In another example, a Texas consumer who believed he was enrolled in a comprehensive insurance policy received a $67,000 hospital bill after a heart attack. In fact, he had a fixed indemnity policy that provided a cash benefit of less than $200 per day of hospitalization. According to NAIC data, the medical loss…

CHIR Experts Testify About Facility Fees Before Maryland General Assembly

Posted by

…be charged) and bars health care providers from collecting more than the insurer-contracted facility fee rate when consumers have not met their deductible. More narrowly, health care providers in Colorado will be prohibited from balance billing consumers for facility fee charges for preventive services provided in an outpatient setting beginning July 1, 2024. 5. Prohibitions on Outpatient Facility Fees: Stopping…

Stakeholders Weigh in on a Proposal that Could Expand Adult Dental Coverage

Posted by

…diagnosis, treatment, and follow-up care (including supplies, appliances and devices).” Both the ADA and the CDA also recommended a required dental loss ratio (often referred to as a DLR), similar to a medical loss ratio (MLR), to ensure dental plans spend a minimum share of premium dollars on dental care rather than administrative costs and profits. Other comments, however, asked…

Stakeholder Perspectives on CMS’s 2025 Notice of Benefits and Payment Parameters: Consumer Advocates

Posted by

…in Marketplace coverage. Special enrollment periods When consumers enroll on the FFM through a special enrollment period (SEP)—a mid-year enrollment opportunity triggered by the loss of coverage or another “qualifying life event”—coverage starts at the beginning of the month immediately following the enrollment date. Currently, some SBMs delay coverage effective dates if enrollment occurs in the latter half of the…

Stakeholder Perspectives on CMS’s 2025 Notice of Benefit and Payment Parameters: Health Insurers and Brokers

Posted by

…to require that transitioning states document how they would make up for enrollment losses, if they decline to use the Enhanced Direct Enrollment (EDE) functionality that now drives much of HealthCare.gov’s enrollment. Network Standards Health insurance companies were less welcoming of proposals to raise the bar for Marketplace plans by extending the federal Marketplace’s network adequacy standards to insurers participating…

Proposed 2025 Payment Rule: Marketplace Standards And Insurance Reforms

Posted by

…continue to be considered EHB, and there would be no defrayal requirement. HHS argues that this change will make the identification of benefits in addition to EHB “more intuitive.” The agency acknowledges that there are states that may have been defraying the costs of benefits under the current policy that would be able to stop if this proposal is finalized….

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.