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 could have tax liability implications.
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.
The State Network hosted a Small Group Convening in Boston, MA on July 10-11, 2014, bringing together state officials and technical experts to discuss QHP and IAP renewals in advance of the upcoming open enrollment period. The meeting provided officials from several states within and outside of State Network an opportunity to discuss strategies for confronting potential issues related to the renewals process.
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.
Rate Development, Filing and Review – A Compilation of Guidance and Expectations for 2015 Rates Webinar
Departments of insurance and insurers are currently preparing for the next round of rate development, filing and review. Rates for 2014 were developed based on considerable speculation on the expected impact of the ACA market reforms on the number and health risk of individuals who would enroll. Early enrollment information will be available for the 2015 rate development and review process, however, robust health risk information may still be unavailable.
With the first open enrollment period having come to an end, states are immediately gearing back up to ensure that consumers again have strong plan options available on the Marketplace for 2015. Insurers will soon be filing forms and rates with state insurance departments, and regulators will be working through those filings to certify products to be offered on the Marketplace during the next open enrollment period.
The Mental Health Parity and Addiction Equity Act (MHPAEA) Issuer Checklist and Certification has been developed by the Georgetown University Health Policy Institute for use by insurance regulators in reviewing products filed by issuers for compliance with MHPAEA.
The Issuer Essential Health Benefits (EHB) Crosswalk and Certification has been developed by the Georgetown University Health Policy Institute to help insurance regulators ensure that product filings include the required EHBs as set forth in the applicable state benchmark plan. Regulators can use the tool provided here, requiring issuers to complete the Crosswalk and Certification
As part of a series on “Helping Consumers Understand the Marketplaces,” Manatt Health Solutions led a webinar reviewing a primer on the reconciliation of advance premium tax credits (APTC), explaining how reconciliation will work when consumers file their taxes, and strategies consumers can use to minimize the risk of repayment.
This brief, prepared by the Georgetown University Health Policy Institute, explores some of the discrepancies that can arise with varying network adequacy standards and provides examples of how some states have resolved such issues. Network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all health care services included under the terms of the contract.