Search Results for: stop-loss

Mitigating Coverage Loss When the Public Health Emergency Ends: The Role of the Affordable Care Act Marketplaces

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…depend largely on marketplace officials. In a new post for the Commonwealth Fund’s To the Point blog, CHIR’s Sabrina Corlette and Maanasa Kona discuss the important role that ACA marketplaces will play in mitigating coverage losses. Their piece identifies basic as well as more innovative strategies marketplaces can adopt to help consumers make a smooth transition to affordable, comprehensive coverage….

The Expiration of the Public Health Emergency Also Ends Policies to Lower Health Access Barriers

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…the pandemic, in exchange for enhanced federal funding. Separately, CHIR has highlighted states’ daunting task of processing redeterminations for an estimated 86 million people and limiting coverage losses. But Medicaid is not the only program affected by pandemic relief policies that expire at the end of the PHE. Additional policies mandate coverage of COVID-19 tests and related care, lower barriers…

March Research Roundup: What We’re Reading

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…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…

Preparing for the Biggest Coverage Event Since the ACA: The Role of States as Medicaid Continuous Coverage Comes to an End

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…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…

Stakeholder Perspectives on CMS’s 2023 Notice of Benefit and Payment Parameters: State Insurance Departments and Marketplaces

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…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…

Stakeholder Perspectives on CMS’s 2023 Notice of Benefit and Payment Parameters: Insurers and Brokers

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…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…

Where the Bread is Really Buttered: Insurers’ Q4 Earnings Reports Show Heavy Reliance on Government Business

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…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…

New Data Show Medical Debt Disproportionately Affects the Most Vulnerable Populations

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…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…

Questionable Quality Improvement Expenses Drive Proposed Changes to Medical Loss Ratio Reporting

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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…

January Research Roundup: What We’re Reading

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…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…

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