Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Individual Health Insurance Market

Handful of States Propose Lower ACA Premium Rates for 2019

September 10, 2018 - Several states have announced lower ACA premium rates for 2019, bucking a national trend brought on by unstable markets and regulatory changes.   While early proposals from a number of states, including Virginia, Maryland, and Oregon, indicated that premiums were likely to rise significantly in the upcoming plan year, other regions such as Tennessee, New Hampshire, Pennsylvania,...


More Articles

Payers Sue to Collect 2017 Cost Sharing Reduction Payments

by Thomas Beaton

Payer organizations are exercising their right to use the court system to collect cost sharing reduction (CSR) payments that were not provided in the last quarter of 2017. A number of lawsuits are challenging the government’s...

How to Curb Adverse Selection in the Individual Health Plan Market

by Thomas Beaton

Maintaining a profitable individual health plan product is already challenging, but adverse selection can create additional problems that impede a payer’s ability to control health plan costs. Policies within the Affordable Care...

ACA Health Insurance Tax to Cost $16B, Lead to Higher Premiums

by Thomas Beaton

The Affordable Care Act’s health insurance tax (HIT) is expected to levy $16 billion in fees for health insurers by 2020, leading payers to increase premiums by an anticipated 2.2 percent, according to a Oliver-Wyman report...

GAO Critiques HHS Actions on ACA Navigator Program Funding

by Thomas Beaton

The Government Accountability Office (GAO) has questioned the data-driven methodology behind significant reductions in funding for the ACA navigator program and subsequent declines in new enrollment in health insurance plans.   In a...

CMS Tells States to Curb Silver-Loading with Off-Exchange Plans

by Thomas Beaton

CMS is asking state insurance departments to offer more off-exchange health plans in order to reduce silver-loading of qualified health plans (QHP). Silver-loading is the practice of raising premiums so that payers can earn larger federal...

New Jersey Gains CMS Approval for Reinsurance Program

by Thomas Beaton

New Jersey has received approval from CMS to implement a five-year reinsurance program that aims to lower individual health plan premiums by 15 percent. The program will operate from 2019 to 2023 and provide $218 million in reinsurance...

CMS Final Rule Extends Short-Term Health Insurance to 3 Year Max

by Thomas Beaton

CMS has issued a final rule that triples the length of time a beneficiary can keep short-term health insurance. The rule allows individuals to purchase a new short-term, limited benefit health plan that lasts for 12 months, or extend...

Insurance Coverage Rates Dip by 12% Due to High Premium Costs

by Thomas Beaton

Individual health plan enrollment between 2017 and 2018 fell by 12 percent as high premiums and a scarcity of subsidy assistance force consumers out of the market, according to an analysis from the Kaiser Family Foundation (KFF). Health...

CMS Approves Wisconsin State Reinsurance Program

by Thomas Beaton

CMS has approved Wisconsin’s plan to launch a state reinsurance program from 2019 to 2023 to help reduce individual state premiums and control the growth of state healthcare spending. The program, called the Wisconsin Healthcare...

Transitional Health Insurance Plays Key Role in Coverage

by Thomas Beaton

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

X

Sign up for our free newsletter:

Our privacy policy

no, thanks

Continue to site...