Tag: Exchanges

HHS proposed rule covers a slew of ACA provisions

Posted by Nikki Hurt on June 14, 2013

Today, the US Department of Health and Human Services released a proposed rule addressing various facets of the Affordable Care Act (ACA). The 253 page document expands upon guidance previously released to states and stakeholders, covering topics ranging from financial integrity and additional oversight of Exchanges to options available under the Small Business Health Options Program (SHOP). Key provisions provided in the proposed rule include:

• Qualified health plans must accept a wide variety of payment options for premiums. A recent Jackson Hewitt study found a large number of uninsured Americans lack bank accounts, and restrictive payment policies excluding money orders and prepaid debit cards would impede the ability of these uninsured Americans to gain insurance access.
• Additional guidance was provided for federally-facilitated Exchange (FFE) states that choose to operate their own SHOP market while the federal government maintains oversight of their individual market, known as the Utah plan. The proposed rule states that data sharing requirements between SHOP and individual markets do not apply in these arrangements. Additionally, states operating their own SHOP Exchange can have their own set of Navigators, separate from the individual market, that perform outreach to small businesses.

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Urban Institute examines state roles in FFE

Posted by Nikki Hurt on

A new report published by Urban Institute describes the different roles states are playing in their respective federally-facilitated Exchanges (FFE). The Affordable Care Act (ACA) requires every state to host an online individual and small group insurance market, and states that elected not to set up their own Exchange defaulted to FFE. State-Level Progress in Implementation of Federally Facilitated Exchanges, funded by the Robert Wood Johnson Foundation, discusses three case studies of states that are implementing FFE, including the various responsibilities each state has undertaken and the challenges they are facing. Several states, for instance, are playing active roles in the development of their respective Exchanges, while one state is significantly behind as a result of political and administrative setback.

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CRS report explains ACA premium tax credits

Posted by Nikki Hurt on June 11, 2013

The Congressional Research Service (CRS) published a new report demystifying how individuals may qualify for premium tax credits to help offset the costs of obtaining insurance through Exchanges. Health Insurance Exchanges Under the Patient Protection and Affordable Care Act (ACA) outlines the requirements for tax credit eligibility, such as having a household income between 100-400% of the federal poverty level. The report also details how the US Department of Treasury (DoT) will send monthly premiums to insurance companies on behalf of enrollees receiving the tax credit. Tax credits are advanceable and refundable, meaning receipt of the credit will coincide with the time at which monthly premiums are due. Furthermore, each Exchange is responsible for determining tax credit eligibility and the appropriate credit amount for qualifying individuals.

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Explaining Recent Changes in CBO Projections of Health Insurance Coverage and Costs under the Affordable Care Act

Posted by Nikki Hurt on June 5, 2013

In May 2013, the Congressional Budget Office (CBO) issued its latest update of estimates of health insurance coverage and costs under the Affordable Care Act. This Implementation Brief summarizes the changes in CBO’s estimates over time, focusing on three key sets of estimates…

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White House memo describes choices and competition in Exchanges

Posted by Nikki Hurt on June 4, 2013

The White House recently released a memo detailing health plan competition and choices anticipated to be available under the Affordable Care Act’s (ACA) health insurance Exchanges. According to the memo, 75% of states with federally-facilitated insurance markets will have at least one new insurance carrier enter their market. The White House memo also reported that 90% of target enrollees will be able to select plans offered by a minimum of five insurance companies. These findings were compared to the current individual insurance market, where two or fewer insurance companies control the market in most states. The memo confirms that state-specific rates will not be released for federally-facilitated Exchanges until September.

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CA releases proposed premium rates for 2014

Posted by Nikki Hurt on May 23, 2013

This morning, California published proposed premium rates from 13 issuers to be offered on the state’s health insurance Exchange, Covered California. California chose to negotiate rates with insurers through active purchasing, meaning that Covered California worked directly with the insurance companies on determining the plans that would be offered on the Exchange. Initially, 33 issuers had applied to offer plans through Covered California, but that number significantly dwindled in response to proposed premiums that were set too high and issuers that were not able to be the “active partners” Covered California required.

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CO releases 2014 Exchange rates

Posted by Nikki Hurt on May 22, 2013

Colorado became the sixth state to post their proposed premium rates for plans entering the state’s 2014 state-based insurance Exchange. In total, 831 health insurance plans, including both individual and small-group options, have been proposed by 17 issuers. Reviews of the proposed plans are currently being conducted by the Colorado Division of Insurance and are scheduled to be completed by July 31st.

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CMS State Resources FAQ: Medicaid Eligibility Determinations, Medicaid/Exchange Interactions, and §1115 Demonstrations that Use Enrollment Caps

Posted by Nikki Hurt on

The interaction between Medicaid and Exchanges around eligibility determination issues represents one of the most important and complex aspects of the ACA. An estimated 28 million adults, along with 19 million children, can be expected to transition at least once annually between insurance affordability programs, as Medicaid and premium subsidies are termed under implementing CMS regulations. Collaboration between Medicaid agencies and Exchanges is essential in order to avert unnecessary delays in eligibility determinations and breaks in coverage that in turn can affect not only the affordability of care but access itself, given the link between coverage and health care access through plans’ provider networks…

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WA releases Exchange premiums

Posted by Nikki Hurt on May 20, 2013

The Washington State Office of the Insurance Commissioner (OIC) recently released proposed premium rates for their state-based health insurance Exchange, Washington Health Plan Finder. Fears of rate increases were assuaged, as the plans presented ultimately indicated more coverage at a reduced cost, attributable to Washington’s already competitive insurance market. The proposed rates must be evaluated by OIC prior to being issued on the Exchange.

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CCIIO releases Marketplace FAQ

Posted by Nikki Hurt on May 17, 2013

The Center for Consumer Information and Insurance Oversight (CCIIO), a division of the Centers for Medicare and Medicaid Services (CMS), recently posted new guidance concerning federally-facilitated and state-based Exchanges (Marketplaces) established under the Affordable Care Act (ACA). The guidance purports that if states do not adhere to and enforce the requisite standards for health insurance issuers in federally-facilitated Exchanges, then CMS intends to coerce enforcement through civil penalties and plan decertification. CMS does not believe that decertification will be a common occurrence. In addition, the guidance stated that qualified health plans (QHP) paired with health savings accounts (HSA) must meet the cost-sharing reduction standards that apply to low income-individuals.

CCIIO published additional guidance that expands upon which activities, in both federally-facilitated and state-based Marketplaces, that qualify for grant funding under ACA Section 1311. For instance, state-based Marketplaces are not permitted to use this funding for navigator outreach and education, yet they are allowed to use Section 1311 funds for “in-person assistance programs.”

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