…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….
…financial assistance will be key to protecting coverage gains. Looking ahead, policymakers will need to consider an extension of the Inflation Reduction Act’s enhanced Marketplace subsidies to avoid significant coverage losses after plan year 2025. Rebecca Silliman, Erin McNally, Cruz Vargas-Sullivan, and David Schleifer, Searching for In-network Mental Health Care with Marketplace Insurance, Public Agenda. Between October 11–November 14, 2022,…
…in bronze or gold plans. While modeling suggests that resulting coverage losses would be small, this concern has prompted Oregon to consider ways to mitigate the higher premiums for affected enrollees. State Fiscal Impacts The cost of a BHP to the state depends in part on the generosity of the coverage provided. But the cost also depends on how the…
…plans that small employers purchase come with low attachment points for stop-loss coverage. Since the employer pays a monthly amount to the stop-loss issuer that resembles a premium, they may not realize they have become the sponsor of (and taken on the fiduciary duties for) a self-funded plan. The NAIC has documented several consumer protection concerns associated with level funding arrangements, including…
…millions of Americans will lose Medicaid and experience higher Marketplace premiums, and the currently record-low uninsured rate is expected to increase. Despite efforts to reduce coverage loss during the unwinding of continuous Medicaid, CBO projections suggest those may be insufficient to stem coverage losses. Further, the estimates are a wake-up call for policymakers to start planning for the end of…
…legislation: High health care costs are driving many small employers out of the fully insured group market and into “level-funded” health insurance arrangements. These products combine a self-funded health plan with a stop-loss insurance policy. An estimated 35% of covered workers in small firms are now in a level-funded health plan. In general, self-funded employer plans purchase stop-loss insurance to…
By Sabrina Corlette, Rachel Swindle, and Rachel Schwab The Affordable Care Act (ACA) established health insurance Marketplaces (or “Exchanges”) to facilitate enrollment in comprehensive and affordable health insurance plans. The ACA envisioned that the Marketplaces would be primarily state-run, with the federal government stepping in as a backstop. In practice, due in part to deep anti-ACA sentiment among some state…
…lose Medicaid during the “unwinding,” outreach to inform consumers of other affordable health insurance options will help mitigate widespread coverage loss. John Holahan, Erik Wengle, and Claire O’Brien, Changes in Marketplace Premiums and Insurer Participation, 2022-2023, Urban Institute, April 2023. Researchers used data from over 503 rating regions in 33 states to calculate average benchmark premiums and premium growth rates…
…treatments to some extent once the government stops footing the bill, consumers could face high out-of-pocket costs (as is already common for many prescription drugs). Telehealth Telehealth utilization grew exponentially during the pandemic, particularly among Medicare beneficiaries, whose share of telehealth visits increased 63-fold from 2019 to 2020. The federal government helped increase access to telehealth by allowing providers to…
…level-funded products in significant numbers, it will leave employers with older, sicker workers behind. This causes adverse selection, where premium rates rise for employers whose groups cannot pass the stop-loss issuers’ underwriting. Just as with AHPs, this legislation does nothing to address the underlying reason why there is an affordability crisis for ESI: the prices that commercial insurers pay for…
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