Posted on November 26, 2013 | Comments Off
The administration announced that enrollment in the federally-facilitated Small Business Health Options Program (SHOP) will be delayed until November 2014. SHOP was created to promote and facilitate the enrollment of small business employees into health insurance plans under the Affordable Care Act (ACA). According to the administration, small businesses may still enroll their employees into health plans through paper applications or by contacting an insurance agent or broker. The administration stated they wanted to ensure SHOP contained all of the necessary features and that enrollment would be smooth before making the site fully operational.
Posted on November 26, 2013 | Comments Off
In response to changes made by the administration’s new transitional policy, which continues plans slated for cancellation under the Affordable Care Act (ACA), the US Department of Health and Human Services (HHS) issued a proposed rule to modify the health insurance risk pool. The proposed rule, 255 pages in length, outlines changes in payment parameters and oversight for the “triple r”- risk adjustment, risk corridors, and reinsurance.
In addition to changes to the “triple r,” this rule formally announces the administration’s decision to delay annual open enrollment for 2015, which will now be held November 15, 2014 through January 15, 2015. HHS also delayed the Exchange blueprint submission deadline for states choosing to operate their own health insurance marketplace in future years. States applying to create their own Exchange must submit their materials to HHS by June 1st of the year prior to opening the Exchange, and HHS will certify the Exchange by June 15.
Posted on November 22, 2013 | Public Comment (1)
The Robert Wood Johnson Foundation (RWJF), in conjunction with Georgetown University’s Center on Health Insurance Reform, recently published their Navigator Review Guide. Navigators are trained to help individuals understand their coverage options under the Affordable Care Act (ACA) and help them select plans most appropriate for their needs. The Navigator Resource Guide is divided into three sections:
- Enrollment issues for individuals without coverage options from an employer;
- Enrollment issues for individuals with coverage options from an employer, but who may want to learn more about additional options under the ACA; and
- Enrollment issues for small employers.
The 102 page document is designed to provide additional information and supplement the training for navigators working with private insurance under the ACA.
Posted on November 22, 2013 | Comments Off
The Centers for Medicare and Medicaid Services (CMS) released several sample letters that may be used to notify plan members of their options in regards to the transitional policy announced last week. The transitional policy effectively states that individuals or small businesses currently enrolled in plans that would be cancelled by the Affordable Care Act (ACA) may remain in or re-enroll in these plans. CMS provided three documents concerning this issue: a sample letter to be sent to individuals that have already received a cancellation notice for their coverage, a sample letter to individuals that have yet to receive a cancellation notice, and a document containing standard language that will satisfy the notification requirement under the transitional policy.
Will People Who Enroll in Health Insurance Marketplace QHPs be Able to Qualify for Premium Assistance if they Enroll Directly through an Insurer’s Website?
Posted on November 20, 2013 | Comments Off
The Administration recently announced that its improvements to Healthcare.gov, the federal Health Insurance Marketplace, will include a new direct purchase feature that enables individuals to buy an Exchange-certified qualified health plan (QHP) directly at the website of the insurer who sells the plan. A question has arisen as to whether such an arrangement is lawful from a subsidy perspective: that is, whether direct enrollment at the QHP issuer website counts as…
Implementation Brief Questions and Answers about the Administration’s Transition Plan to Address Health Insurance Policy Cancellations
Posted on November 18, 2013 | Comments Off
On November 14th, 2013, the Obama Administration announced a plan to address a situation that began to emerge in earnest a number of weeks ago and that finally exploded into view within the past couple of weeks: people covered by individual insurance plans who were receiving notices from their insurers that their policies would be cancelled at the end of 2013 because they did not meet new coverage requirements set to take effect in January 2014. The number of people affected by policy cancellation notices is not clear, but most estimates suggest that one half or more of the 15 million people in the individual market could be affected. Manhattan Institute scholar Avik Roy placed the number at 4.8 million (so far). Washington Post reporter Sarah Kliff noted that the figure is hard to calculate but is likely to affect between 7 and 12 million people.
Posted on November 14, 2013 | Comments Off
A letter written to state insurance commissioners from Gary Cohen, Direct of the Center for Consumer Information and Insurance Oversight (CCIIO), encouraged states to adopt a transitional policy concerning cancellation of health plans as a result of the Affordable Care Act (ACA). The letter states that active plans in the individual and small group markets may be renewed for the 2014 plan year if (1) the plan was in effect as of October 1st, 2013 and (2) the insurance issuer sends a letter to plan members that have or will have their plans terminated. The letter should describe:
- changes in available insurance options;
- how the plan member’s current plan deviates from the market reforms instituted by the ACA (i.e. no coverage of individuals with pre-existing conditions, no guaranteed issuance, etc.);
- the right and ability of a plan member to enroll in a plan through the ACA’s health insurance marketplaces;
- how a plan member may enroll in a new plan through the ACA marketplaces; and
- the ability of the plan member to enroll in another plan outside of the marketplaces that adheres to ACA market reforms.
Posted on November 13, 2013 | Public Comment (1)
Today, the US Department of Health and Human Services (HHS) issued the first set of enrollment statistics for health insurance plans offered through the Affordable Care Act’s (ACA) Marketplaces. The report stated that 106,185 individuals signed up for coverage during the first month of open enrollment. About 75% of these individuals enrolled through State-Based Marketplaces. The remainder, about 26,000 people, reside in a state in which the Marketplace is operated by the federal government. While these individuals have completed the enrollment process, they have not necessarily purchased a plan.
Posted on November 8, 2013 | Comments Off
The Department of Health and Human Services (HHS), Department of Labor (DoL), and the Department of the Treasury (DoT) released the joint final rule implementing the Mental Health Parity and Addiction Equity Act of 2008. Under this law, insurers that offer coverage for mental health services are expected to treat mental health equitably, meaning cost-sharing and limits for mental health services should be comparable to that of physical health services. Several other specific provisions addressed in this rule include:
- Parity for intermediate care offered in residential or outpatient settings and all plan standards (i.e. network adequacy and geographic limits);
- Clarifying transparency expectations for insurers to remain compliant with the law; and
- Eliminating provisions that enabled insurers to make exceptions for parity requirements for certain benefits offered.
The law was passed in 2008, and an interim final rule was issued in January 2010. The Centers for Medicare and Medicaid Services (CMS) also published an FAQ on today’s rule.
Posted on November 5, 2013 | Comments Off
An analysis performed by the Kaiser Family Foundation found that nearly 6 in 10 Americans eligible to participate in the Affordable Care Act’s (ACA) health insurance marketplaces, which equates to 17 million individuals, will qualify for insurance subsidies. To receive a subsidy through the ACA, individuals must earn between 100-400% of the federal poverty line. Most of the individuals qualifying for subsidies reside in Texas, California, and Florida. The analysis was based on population and economic data collected by the Census Bureau for 2012 and 3013, stated that.