Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Individual health insurance market

Transitional Health Insurance Plays Key Role in Coverage

July 10, 2018 - Transitional health insurance, otherwise known as a short-term health plan, is a temporary insurance policy intended to provide stop-gap coverage when an individual is in between ACA compliant policies.  The National Association of Insurance Commissioners estimates that more than 160,000 people enrolled in transitional policies during 2016. Transitional health insurance is a unique fixture...

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CMS Suspends $10.4B in Risk Adjustment Payments to Payers

by Thomas Beaton

CMS has temporarily withheld $10.4 billion in risk adjustment payments for 654 healthcare payers, citing a ruling in the US District Court of New Mexico that invalidated the agency’s risk adjustment methodology. The ruling, which took place...

CMS: Individual Health Plan, Federal Exchange Challenges Remain

by Thomas Beaton

CMS has released three new reports indicating that the individual health plan and federal exchange markets faltered somewhat in 2017 because of increasing premiums, decreasing competition, and stagnant enrollment. The agency believes that the...

How to Drive Enrollment in the ACA Health Plan Marketplaces

by Thomas Beaton

Payers and states wishing to increase enrollment in the ACA health plan marketplaces should  create targeted advertisements, benchmark silver-tier plans as their primary exchange plan, and help consumers navigate health plan purchases, according...

Department of Labor Finalizes Association Health Plan Expansion

by Thomas Beaton

The Department of Labor (DOL) has issued a final rule that expands consumer availability of association health plans (AHPs) starting on September 1, 2018. The rule comes months after President Trump and the DOL proposed executive changes that...

US Court: Payers Are Responsible for Risk Corridor Program Costs

by Thomas Beaton

Federal judges in the US Federal Circuit Court of Appeals have issued an opinion stating that healthcare payers, and not HHS, are responsible for the costs of the ACA’s risk corridor program. Chief Judge Sharon Prost filed the majority...

BlueCross BlueShield Nets $2.3B in Savings from 2017 Tax Cuts

by Thomas Beaton

BlueCross BlueShield companies saw  a total tax savings of $2.3 billion after passage of last year’s Tax Cuts and Jobs Act (TCJA), according to a new creditor’s briefing from AM Best. BCBS companies reported a mix of gains and...

AHIP, Provider Groups Balk at DOJ Position on ACA Mandates

by Thomas Beaton

AHIP and a number of professional societies and provider groups are urging the Trump Administration to enforce key provisions of the the Affordable Care Act after the Department of Justice (DOJ) said it would not defend the ACA in a federal court...

ACA’s Individual Mandate Boosted High-Income Enrollment Totals

by Thomas Beaton

The Affordable Care Act’s (ACA) individual mandate spurred greater high-income enrollment in health plans and is a key component of increasing enrollment and stability in the nation’s individual insurance markets, according to a new...

Early Health Insurance Premium Proposals Indicate Hikes for 2019

by Thomas Beaton

Significant increases to health insurance premiums are on the horizon for beneficiaries in multiple states as payers begin to share their 2019 rate plans.   A challenging regulatory landscape, complicated by policy changes that have altered...

Uninsured Rate among Working Adults Rises to 15.5% in 2018

by Thomas Beaton

The uninsured rate of working adults ages 19 to 64 rose by more than 3 percent between 2016 and 2018, according to the Commonwealth Fund’s ACA Tracking Survey. In 2016, 12.2 percent of working adults lacked health insurance.  During...

Medicare Advantage, Premium Revenues Drive Q1 Payer Profits

by Thomas Beaton

Healthcare payers experienced strong first quarter profits in 2018 because of sharp growth in Medicare Advantage (MA) enrollment and premium revenues, according to newly released earnings statements. The reports confirm the stability and profitability...

Short-Term Health Plans Lack Mental Health, Prescription Benefits

by Thomas Beaton

Short-term health plans generally lack mental health and prescription drug benefits and may create financial-based health insurance barriers for unhealthy beneficiary populations, according to a Kaiser Family Foundation (KFF) analysis. The KFF...

How Payers Can Succeed in Association Health Plan Markets

by Thomas Beaton

Association health plans (AHPs) may completely alter the nation’s health insurance markets with increasing support from federal entities and a handful of state insurance commissions. An expansion of the AHP market may materialize based...

Maryland Creates State Reinsurance Program to Control Premiums

by Thomas Beaton

Maryland governor Larry Hogan has signed legislation to create a state reinsurance program aimed at stabilizing health plan premium increases. The reinsurance program will use state and federal reinsurance funding to pay catastrophic claims for...

CMS Relaxes Affordable Care Act Health Plan Regulations

by Thomas Beaton

CMS has issued a final rule that relaxes certain Affordable Care Act health plan regulations in an effort to drive competition and affordability within state health insurance markets. The agency said that the new rule will give payers more flexibility...

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....

Rising Medical Costs Created Health Plan Enrollment Shifts in MN

by Thomas Beaton

The Minnesota of Council of Health Plans (MCHP) associated rising beneficiary medical costs in 2017 to irregular health plan enrollment shifts in both the private and public market. The Council said in a press release that a three percent increase...


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