…between early 2019 and early 2021. What it Finds The health insurance safety net, augmented by the Medicaid continuous coverage requirement in the Families First Coronavirus Response Act and the American Rescue Plan’s (ARP) temporary enhancements to marketplace subsidies, did its job of preventing “catastrophic coverage losses” during the pandemic. All three surveys showed statistically insignificant increases in the uninsurance…
…which they are working to overcome several challenges, including lack of lead time, workload and staffing challenges, lack of data, technology glitches, and market instability. Several states are pursuing innovative strategies to mitigate coverage loss and ease consumers’ transitions into alternative sources of coverage. You can read the full brief here. Medicaid and CHIP Eligibility and Enrollment Policies as of…
…also proposed giving SBMs greater flexibility on pre-enrollment verification for SEPs, and only requiring such verification on HealthCare.gov for the loss of minimum essential coverage (MEC) SEP. Comments on this proposal unanimously supported the additional flexibility for SBMs. Nevada suggested the “consumer friendly approach” CMS proposed will help prevent adverse selection by removing barriers to enrollment for young and healthy…
…incentives for insurers to select for risk and offer less generous benefits. In contrast, Molina offered its strong support. Medical Loss Ratio (MLR) Requirements CMS has found that insurers are abusing the MLR reporting mechanism by labeling bonus payments to providers as quality improvement activities. Insurers offered a variety of recommendations for CMS’ proposals to establish stricter accounting and reporting…
…Share in Medicare Advantage Medicare Advantage enrollment has experienced significant growth; enrollment in the program has more than doubled in the last ten years. Health plans are taking notice of the business opportunity. On its earnings call, UnitedHealth identified the Medicare Advantage program as a key source of their successful financial performance in 2021. However, Humana reported a loss in…
…Community Service Society of New York found that 55 hospitals had sued about 4,000 patients for medical debt in that period. Hospitals had engaged in these practices despite receiving millions of dollars in pandemic relief to offset pandemic-related losses. Vulnerable Populations Are Most Affected by Medical Debt New studies shed light on how medical debt disproportionately affects the country’s most…
By Karen Davenport Under the Affordable Care Act (ACA), insurers must provide rebates to enrollees when their spending on clinical services and quality improvement, as a proportion of premium dollars, falls below a minimum threshold known as the “medical loss ratio” (MLR). Federal regulators have discovered some insurers are gaming the system by misallocating expenses or inflating their spending on…
…among small employers, it is important to note that it may not reflect the rise of level-funded plans, which market a self-funded plan combined with a low attachment point stop-loss policy. Many small employers may not realize that level funded plans are effectively self-funded plans. Over the long term, it will be important for stakeholders to continue monitoring coverage trends…
…from a health care provider. However, this has not stopped several payers from imposing this requirement (see Table). Meanwhile, some forms also contain explicit warnings about insurance fraud for anyone who submits inaccurate information on their reimbursement request. This, combined with confusion about what exactly they are being asked to attest to, could have a chilling effect on many consumers’…
…reluctance to adopt these models suggests that they will need greater incentives to transition their practices away from FFS and towards value-based APMs. These could be carrots – such as financial support for the necessary infrastructure or technical assistance – or sticks – such as the threat of loss of network status or reductions in reimbursement rates. Given the political…
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