Search Results for: stop-loss

Biden’s Budget Sets Up a Spending Showdown, With ACA Subsidies in the Crosshairs

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…subsidies entirely—corresponding to an annual average loss of $3,277 in subsidies per person. Residents of populous states with high Marketplace enrollment numbers—including California, Florida, Georgia, North Carolina, Pennsylvania, and Texas—would likely face the largest coverage losses and affordability reductions if the enhanced subsidies expire. Governors from these and other states have urged the federal government to make the enhanced subsidies…

The State of State Protections: Maintaining Access to Services after Transitioning from Medicaid

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…transitions. However, even those who successfully shift to another coverage option face the risk of disrupted care and loss of access to providers they were seeing under their Medicaid plans. Many of these people will be in the midst of treatment, pregnant, or have serious chronic conditions. It is, therefore, critically important for states to develop strategies to promote continuity…

Proposed Rules on the ACA’s Frequently Litigated “Birth Control Mandate” Aim to Close Gaps in Coverage

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…pregnancies and a federal backstop to replace state-funded contraceptive services. Access to contraceptive services would occur without any cost sharing on the eligible individual’s part, and “independent of any action by the objecting entity.” Although providers must confirm the consumer’s eligibility for the arrangement, this can be done through an attestation or documents that a plan must already furnish, such…

February Research Roundup: What We’re Reading

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…Spending in the Affordable Care Act Markets, 2015–19, Health Affairs, February 2023. Researchers reviewed claims data from Affordable Care Act (ACA)-compliant individual and small group markets and medical loss ratio data to identify trends and potential drivers in health care spending. The authors assessed utilization, unit prices, and service mix between 2015 and 2019. What it Finds Total per member…

COVID “Long Haulers” Still Struggle with Coverage and Care

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…percent of the time. The availability of appeals beyond this stage varies depending on the type of coverage the patient holds. Public Health Insurance Eligibility Depending on their family’s overall income, patients who experience job loss or loss of income due to long COVID may become eligible for subsidized health plans on the Affordable Care Act Marketplace or qualify for…

A Midterm Assessment Of President Biden’s Promise To Build On The ACA

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…documentation of income. Providing an extra year for subsidized Marketplace enrollees to file a tax return with the Internal Revenue Service and reconcile any advance premium tax credits, before risking the loss of subsidy. Requiring plans on the federally run Marketplace (gov) to offer plans with standardized benefit designs so that consumers can more easily compare. Improving coverage adequacy. Plans…

December Research Roundup: What We’re Reading

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…persist for years—a phenomenon that—as the authors suggest—shows how loss of insurance can create more permanent barriers to accessing the health care system, such as lacking a usual source of care. These findings underscore the need for policies that mitigate the risk of coverage gaps during the transition between Medicaid and other coverage programs.   Jennifer Tolbert, Patrick Drake, and…

November Research Roundup: What We’re Reading

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…percent). Why it Matters With the PHE recently extended into 2023, stakeholders continue to prepare for the massive wave of coverage transitions expected to occur once Medicaid renewals resume. Low levels of consumer awareness about the upcoming resumption of Medicaid renewals are a cause for concern as stakeholders seek to minimize coverage losses. While sources such as social media and…

Supporting Continuity of Coverage from Medicaid into the Marketplace: Post-PHE Considerations for States

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By Jason Levitis* and Sabrina Corlette The unwinding of the Medicaid continuous coverage requirement will trigger the largest coverage transition since the Affordable Care Act (ACA) took effect. More people are projected to leave Medicaid than currently have marketplace coverage, creating a great risk of coverage loss but also a huge enrollment opportunity for marketplaces. States have already made tremendous…

October Research Roundup: What We’re Reading

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…decline in non-ACA-compliant coverage, which can leave consumers at financial risk when they need care. This KFF study suggests that more generous premium subsidies have been key to increasing access to and take up of comprehensive health insurance on the individual market. Adrianna McIntyre, Evidence-Based Outreach Strategies for Minimizing Coverage Loss During Unwinding, JAMA Health Forum, October 2022. The author…

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