Specialty Tier Pharmacy Benefit Designs in Commercial Insurance Policies: Issues and Considerations
As health care costs rise, one of the chief determinants of the rate of increase has been the cost of prescription drugs. Over time, additional tiers have been included in pharmacy benefit designs and, as they were added, cost sharing in the new, higher tiers has increased.
Boosting Enrollment: Lessons Learned from 2013-2014
With the recent conclusion of the initial open enrollment period under the Affordable Care Act, opportunities now exist to examine the experiences and successes of several state-based marketplaces in order to evaluate how they reached consumers and enrolled them in Qualified Health Plans
Addressing the Financial Impact of Renewals: Why Many Enrollees Could Benefit from Shopping
As the 2015 open enrollment period approaches, one of the most significant challenges faced by marketplaces stems from the complicated nature of premium subsidy calculations, which may lead to potentially large swings in consumers’ after-subsidy premiums and tax liability implications.
Applicability of All-Payer Claims Databases for Rate Review and Other Regulatory Functions
All-payer claims databases (APCDs) collect and compile medical, pharmacy, and sometimes dental claims, eligibility, and provider files from public and private payers. APCDs are currently being used for a variety of functions, including population health analysis, comparative analysis of provider and facility quality, cost management for Medicaid and other public programs, support for provider payment reform initiatives, and consumer transparency tools.
Advance Premium Tax Credit Reconciliation Questions and Answers
Under the Affordable Care Act (ACA), individuals seeking health insurance coverage through a Marketplace are assessed for eligibility for an advance payment of the premium tax credit (APTC) based on projected annual income. When eligible individuals file federal income taxes at the end of the year, the Internal Revenue Service (IRS) will reconcile the premium tax credit received based on estimated annual income with what should have been received based on actual income.
Understanding the Potential Role Web Brokers Can Play in State-Based Marketplaces
he Affordable Care Act (ACA) is already greatly expanding individual health insurance coverage, particularly among lower-income uninsured individuals. However, this is neither easy nor inexpensive to sustain, and it will require ongoing, effective public-private partnerships on multiple levels. One potential partnership opportunity is with “web brokers” who sell individual health insurance online, functioning as private distribution channels in a fashion similar to the new Marketplaces and offering a choice of health plans from multiple insurers, while relying primarily on websites and call centers for customer service.
Early Impacts of the Affordable Care Act on Health Insurance Coverage in Minnesota
With full implementation of the health insurance coverage provisions of the Affordable Care Act (ACA) on January 1, 2014, there has been great interest in assessing the law’s early impact on health insurance coverage in Minnesota.
Realizing Rural Care Coordination: Considerations and Action Steps for State Policy-Makers
This issue brief draws from the experiences of six states, Alabama, Colorado, Montana, New Mexico, North Carolina, and Vermont, to identify common policy considerations and action steps for coordinating care in rural environments.
Consumer Assistance Resource Guide: American Indians and Alaska Natives
Early evidence from across the nation suggests that consumer assisters are playing a vital role in helping people enroll in the new coverage options made possible by the Affordable Care Act (ACA). The State Health Reform Assistance Network has engaged with a number of states to develop easy to understand materials to educate consumer assisters about various issues that may confuse consumers and the assisters trying to help them during the eligibility determination and enrollment process.
Implications of Health Reform for American Indian and Alaska Native Populations
The Affordable Care Act (ACA) has important implications for American Indians and Alaska Natives (AI/AN), including the expansion of Medicaid coverage to nearly 400,000 currently uninsured AI/AN individuals.