Private Payers News

Open Enrollment Dates Announced for Health Insurance Exchange

In 2017 and 2018, open enrollment for coverage through the health insurance exchange will take place on November 1 and continue until January 31 of the following year.

By Vera Gruessner

- Earlier this week, the Centers for Medicare & Medicaid Services (CMS) released its yearly Notice of Benefit and Payment Parameters related to the coverage options on the federal health insurance exchange in 2017. The rulings outline ways to assist consumers with out-of-network costs at in-network medical facilities, a press release from CMS stated.

Affordable Care Act

The notice also notifies beneficiaries when providers move outside of their network, transforms the risk adjustment formula, and offers ratings through HealthCare.gov. These ratings allow consumers to make the best decisions for their healthcare coverage selection.

Future open enrollment dates

In order to assist health payers in planning out the future of their insurance plans, CMS finalized the open enrollment dates for future years. In 2017 and 2018, open enrollment for coverage through the health insurance exchange will take place on November 1 and continue until January 31 of the following year. In the year 2019, open enrollment via the health insurance exchange will start on November 1 and end on December 15, CMS announced.

“As the Health Insurance Marketplace continues to mature, we are able to focus on strategies that help it work even better for consumers and insurers,” Kevin Counihan, CEO of the Health Insurance Marketplaces, stated in the press release. “That means making targeted improvements that keep the Marketplace working smoothly for consumers and keeps the Marketplace an attractive place to do business.”

For more information about the final Notice of Benefit and Payment Parameters for 2017, click here. Along with the risk adjustment formula calibration, CMS has set the premium adjustment percentage at 13.3 percent.

The ACA’s Medicaid expansion provision

The Affordable Care Act has pushed forward a medical coverage system in which more American citizens will receive insurance and obtain healthcare access. The individual mandate, for instance, has required eligible citizens to purchase insurance or else risk a tax penalty.

Through the federal health insurance exchange and the state marketplaces, payers have sold health plans and consumers have received coverage. However, how were low-income individuals and families expected to pay for health insurance? Were they left in the dust?

The Affordable Care Act set up a form of Medicaid expansion that would offer healthcare access among low-income people. However, after the Supreme Court ruled that Medicaid expansion would be voluntary among states, a large number of states declined to broaden their Medicaid program. This essentially blocked many individuals from obtaining healthcare access.

Primary care visits increase among Medicaid population

A report from athenahealth, Inc. and the Robert Wood Johnson Foundation uncovered that primary care physicians working within states that expanded Medicaid coverage have treated substantially more Medicaid beneficiaries than primary care doctors in states that declined Medicaid expansion.

While in states that expanded the Medicaid program, 21.2 percent of primary care visits were from Medicaid beneficiaries, states that chose not to grow the program, saw less than 10 percent of primary care visits from this particular population.

“This data shows that most physicians have started to see more Medicaid patients, and many of these patients are forming ongoing relationships with providers and addressing chronic conditions and other health issues,” Kathy Hempstead, who directs coverage concerns at the Robert Wood Johnson Foundation, said in a public statement. “Through the report, we can see one of the tangible benefits of providing people with financial access to health, which has been a major accomplishment of the ACA.”

The Robert Wood Johnson Foundation report incorporated data from nearly 22,000 healthcare providers which consisted of about 5,000 primary care doctors. The report looked at how the Affordable Care Act specifically impacted the life of patients and the work of physicians.

The report discovered that, starting in 2014, the number of visits to PCPs increased significantly among Medicaid beneficiaries. Additionally, more primary care practices began accepting Medicaid patients.

Two out of three Medicaid patients who went to see their primary care physician also had a follow-up within 18 months. Along with this statistic, follow-up visits increased and were more likely among patients with a higher number of chronic diseases.

Among patients with private health insurance plans, there were 125,000 additional free visits to primary care doctors in 2015 when compared to the results in 2011. This spike in visits is attributed to the Affordable Care Act within the report.

However, it was also discovered that those with private health plans were paying a bit more out-of-pocket to see their primary care physicians in 2015 as opposed to 2011. The costs of surgical visits also rose from $62.44 to $74.42.

“We’re finding that in Medicaid expansion states, many physicians are opening their practices to people with Medicaid coverage and establishing ongoing relationships with them, especially those with serious chronic diseases,” Josh Gray, Vice President of athenaResearch at athenahealth, said in a press release.

“But while patient costs for surgery are high and growing fast, this hasn’t been a major issue for primary care. Moving forward, we will be looking at whether new insurance coverage is translating to better health outcomes for Medicaid patients.”

The report also looked at healthcare access among uninsured patients and it was found that the uninsured had shorter primary care visits at 13.2 minutes compared to 14.5 minutes. Additionally, revenue among PCPs increased by 2.4 percent in 2014.

The Affordable Care Act has brought more coverage options for American citizens by providing federal subsidies through the health insurance exchange as well as the potential for Medicaid expansion among states.

Image Credits: Robert Wood Johnson Foundation and athenahealth