Under the Affordable Care Act (ACA), states are responsible for implementing a complex array of health reforms, most notably Health Insurance Exchanges, Medicaid expansion, and health insurance market regulations. ACA presents states, particularly state Medicaid agencies and insurance departments, with unprecedented policy, fiscal, programmatic, operational, and systems challenges.
A helpful new...
Health insurance plans are required to report their administrative expenses. For health plans in the for the large group, small group, and individual insured markets, an new report from Milliman details insurers’ administrative expenses in five categories:
Expenses for improving healthcare quality
Claims adjustment expenses
Agents and brokers fees and commissions
Direct sales...
The Patient Protection and Affordable Care Act (ACA) requires benefit plans offer a minimum set of essential health benefits. Those include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitation and habilitative services and devices, and laboratory services.
The...
A new report outlines the key principles and various options for funding the operating costs of Health Insurance Exchanges mandated under the Affordable Care Act. Nevada’s Silver State Health Insurance Exchange describes methods other states are using or may use to finance day-to-day operations of a Health Insurance Exchange...
The Affordable Care Act (ACA) requires that most Americans have health insurance that meets minimum federal requirements. Under the controversial mandate, starting in 2014, most individuals under 65 must purchase minimum essential health insurance coverage or pay a penalty to the IRS. One practical concern is that healthy individuals...
As part of the Health Reform Toolkit Series, the Blue Cross Blue Shield of Massachusetts Foundation, the Robert Wood Johnson Foundation, and the Commonwealth Health Insurance Connector Authority have published Effective Education, Outreach, and Enrollment Approaches for Populations Newly Eligible for Health Coverage. The series offers resources for health...
A new report examines individual eligibility for federal premium subsidies in Health Insurance Exchanges when employer-sponsored or public coverage is not available to them. Both federal premium subsidies and state or federally-run Health Insurance Exchanges are features starting in 2014 under the Affordable Care Act (ACA).
While most individuals will be required to...
With an array of payment reforms, quality and safety requirements, massive expansion of Medicaid, and creation of the new State Health Benefit Exchange marketplace, the Affordable Care Act (ACA) presents extraordinary new challenges for compliance, especially for health plans, physicians, hospitals and health systems, and drug and device manufacturers.
In...
As part of health reform implementation, states will create a large and complex new marketplace for the buying and selling of health insurance coverage. Through State Exchanges, individuals and small businesses may buy federally defined benefit packages from state licensed and certified Qualified Health Plans.
For health plans, this is...
