Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Health Insurance Exchange

Medicaid Plans More Cost Effective, Stable than Exchange Plans

May 23, 2018 - Medicaid health plans are more cost effective than federal exchange plans and could offer beneficiaries more affordable coverage options, according to a UnitedHealth Group analysis. UnitedHealth Group said that federal healthcare agencies could create more affordable health plans for low-income individuals if CMS redistributes funding currently spent on the exchanges into Medicaid. “The...


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11.8M Members Bought Health Plans Via Affordable Care Act Exchanges

by Thomas Beaton

Nearly 11.8 million beneficiaries have enrolled or re-enrolled in a health plan through the Affordable Care Act exchanges, reaching close to 2017 enrollment totals (12.2 million) despite federal changes in how the exchanges are funded and operated....

Affordable Care Act Changes May Bring a Rocky 2018 for Payers

by Thomas Beaton

2017 was a turbulent year for the Affordable Care Act.  Legislative battles in Congress, fluctuating support from healthcare stakeholders, and threats of repeal have left many payers facing an uncertain future. Even though Congress has not...

NB and IA Offer New Individual Market Plan For Open Enrollment

by Thomas Beaton

An new individual market plan created out of Medica and CHI Health will be available to consumers during the open enrollment period in Nebraska and Iowa, the health networks announced in a press release. The Medica with CHI Health plan offers...

Planning for Individual Insurance Exchange Stabilization in WA

by Thomas Beaton

State health insurance markets and their individual insurance exchanges have faced regular instability in the form of payer exits, imbalanced risk pools, and rising premiums that push out new and returning insurance consumers. As premiums go...

Governors Propose Health Insurance Market Stabilization Plan

by Thomas Beaton

Eight state governors have outlined their proposals for a health insurance market stabilization plan that would control premium increases and improve competition in the federal and state health insurance exchanges. In a letter sent to Congress,...

HHS to Spend $10M on Affordable Care Act Navigator Program

by Thomas Beaton

HHS and CMS announced that they will allocate $10 million to support the Affordable Care Act Navigator program, which helps health insurance consumers find coverage solutions during the Open Enrollment period. Launched in 2013, the Navigator...

As ACA Debate Lingers, Non-Marketplace Members Present Risks

by Thomas Beaton

While much of the national debate over health insurance has focused on the options open to ACA marketplace enrollees, payers should be careful not to neglect coverage choices for their private plan customers, who tend to be healthier and wealthier,...

Anthem to Withdraw from ACA Individual Market Exchanges in NV

by Thomas Beaton

Anthem BlueCross BlueShield (BCBS) will completely withdraw from Nevada’s ACA exchange for individual health plans in 2018, the health payer announced on Monday. The payer’s decision follows discussion with state leaders and regulators....

HHS Approves Alaska 1332 Waiver for State Reinsurance Program

by Thomas Beaton

Alaska will be able to move ahead with its plans to implement a state reinsurance program under a  1332 State Innovation Waiver, HHS confirmed this week.   The Alaska Reinsurance Program (ARP) will attempt to stabilize the state’s...

CMS: Reinsurance, Risk Adjustment Programs Worked Well in 2016

by Jesse Migneault

CMS has released the results from 2016 for reinsurance and risk adjustment transfers, two of the “three R’s” used to stabilize premiums in the Affordable Care Act (ACA) marketplaces.   This marks the third year the agency...

Senate Has Released Bill to Revise ACA Repeal Legislation

by Jesse Migneault

The Senate has released the working draft of the Better Care Reconciliation Act of 2017, revising the recently House-passed AHCA.   Both bills aim to repeal and replace the Affordable Care Act (ACA), which was passed in 2010. The AHCA...

Medica Will Stay in NE and IA Health Insurance Exchanges

by Jesse Migneault

Medica has announced plans to stay in the Nebraska and Iowa health insurance exchanges for 2017.   Although committed to the Nebraska exchange, the payer had previously indicated it was going to leave the Iowa marketplace. Both states...

CMS Outlines Special Enrollment Period Rules for ACA Exchanges

by Jesse Migneault

Starting on June 23, 2017, CMS will be enacting its new rules regarding special enrollment periods (SEP) for the ACA marketplace.  The agency released the new special enrollment rules earlier this year that will alter participation criteria...

Facing an Empty Exchange, Iowa Suggests Statewide Insurance Plan

by Jesse Migneault

If Iowa’s health insurance exchanges are completely abandoned, the state will request that the federal government allow the establishment of a state health care plan for 2018. If approved by CMS, the stopgap measure would create the Iowa...

Centene Will Enter Health Insurance Exchanges in 3 New States

by Jesse Migneault

Centene Corporation will expand its presence in a number of state health insurances exchanges in 2018, building on its successful 2017 marketplace results.  The payer is planning to enter the Kansas, Missouri and Nevada...

PA Payer Market Stable, but OH Loses ACA Exchange Participants

by Jesse Migneault

Pennsylvania and Ohio are having very different experiences with their Affordable Care Act health insurance exchanges as they move into 2018. While Pennsylvania’s existing five payers will continue to offer exchange plans at roughly the...

Nevada Legislature: All Residents Should Have Medicaid Access

by Jesse Migneault

The Nevada State Assembly has passed a bill which would open Medicaid enrollment to all of the state’s residents, regardless of income or health status.   The Nevada Care Plan would allow every state resident without health insurance...

$18M Claimant Case Challenges Affordable Care Act Payers

by Jesse Migneault

In April of 2017, Wellmark Blue Cross Blue Shield, which operates in Iowa and South Dakota, announced it would exit the 2018 health insurance exchanges.  The payer cited higher than expected claims costs, including Member X, who had claims...

NC Payer Raises Health Insurance Rates Due to CSR Lawsuit

by Jesse Migneault

Blue Cross Blue Shield of North Carolina announced its 2018 individual premium rates will increase an average of 22.9 percent for coverage on and off the health insurance exchange in all 100 counties it serves.  The increase is a pinch lower...

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