A year ago, I wrote a post in which I expressed the opinion that open enrollment should continue into January every year. At that point, the proposed guidelines from HHS had called for the 2016 open enrollment period to end on December 15, 2015 (ie, next week), and I noted that this would mean people… Read more about Should open enrollment end by December 31 to prevent adverse selection?
Affordable Care Act (ACA)
On Friday, HHS published their proposed benefit and payment parameters for 2017. It’s a good read, if you’re into HHS regulations. They’ll accept comments on the proposals through December 21, and final regulations will likely be published in February or March 2016. open enrollment schedule for 2017 HHS has proposed that open enrollment for 2017… Read more about Standardized plan designs, proposed 2017 max oop, open enrollment, and more
Healthcare accounts for 17.4% of the US GDP. And yet most of us can’t or won’t include a healthcare line-item in our budget that accounts for 17.4% of our annual spending. Whenever health insurance carriers raise their rates – particularly if it’s a significant increase – there tends to be a public outcry, with the carriers… Read more about Lesson from CO-OP failures: low premiums aren’t sustainable unless we reduce healthcare costs
UPDATE, 10/20/15: On October 19, Colorado Health OP filed a lawsuit in Denver District Court, seeking an injunction and temporary restraining order to allow the carrier to continue to sell policies – and participate in the 2016 open enrollment period – while working for the next few weeks to secure funding from one of the… Read more about Why is Colorado Health OP shutting down?
The back-story Last September, when we wrote about the fact that the average individual rates increase in Colorado was less than one percent for 2015, we noted that the overall rate increase was astoundingly low – far lower than anything we’d seen during our time in this industry. And although it will be several more weeks… Read more about Proposed rate increases in Colorado: CO-OP up 21%, Kaiser up 2%
Along with many of my fellow health wonks, I was glued to my computer yesterday morning, waiting to see if today would be the day SCOTUS announced a decision in King v. Burwell. They didn’t, so now we’ve got at least a few more days to wait (currently, the expectation is that the ruling will come… Read more about Is the King lawsuit an attempt to undermine the ACA?
Another school year has come to a close, it’s still daylight well into the evening these days here in the northern hemisphere, and I’ve got summer on the brain. So welcome to the Summertime! edition of the Health Wonk Review! Since King v. Burwell is on a lot of minds these days, I thought we’d… Read more about Summertime! Health Wonk Review
Last week, Ann Doss Helms wrote an article for the Charlotte Observer about Luis Lang, a SC man with diabetes who will go blind if he doesn’t get eye surgery in the near future. In a nutshell, Luis Lang is a Republican who opted to ignore the ACA’s individual mandate in 2014, and he also… Read more about The Luis Lang story – an update and my own thoughts
Now that open enrollment is over, the only way people can enroll in individual health plans is with a qualifying event. This applies both on and off the exchange. Outside of open enrollment, individual/family health insurance is only for sale if you’ve got a special enrollment period triggered by a qualifying event. So what constitutes… Read more about A new job is not a qualifying event for a SEP
Last week, I wrote a post detailing exactly how the ACA’s “short coverage gap” exemption works. In a nutshell, as long as your gap in coverage is less than three months long and you maintain coverage for the rest of the year, you don’t have to pay a penalty for being without coverage. In that… Read more about What if your coverage gap spans two calendar years?
For many of our clients, income and subsidy eligibility determination have replaced medical underwriting as a source of confusion when enrolling in a new health insurance policy. If your income is above 400% of the poverty level (for current enrollments, that’s anything above $46,680 for a single person, and $94,500 for a family of four), it… Read more about A dependent child’s income and MAGI for Medicaid/subsidy eligibility
One of the exemptions from the ACA’s individual mandate penalty is for people who have a short gap in ACA coverage. According to the IRS regulations (see page 53654), there’s no penalty as long as the “continuous period without minimum essential coverage is less than three full calendar months and is the first short coverage… Read more about Short Gap in ACA coverage – IRS Says Three Months is Too Long
Last week, Colorado regulators announced that they won’t allow transitional (“grandmothered”) health plans to renew again at the end of this year, and that all non-ACA-compliant plans (unless they’re grandfathered) will end no later than December 31, 2015 and will need to be replaced with ACA-compliant coverage. Grandfathered Plans Grandfathered plans are those that were… Read more about Colorado clarifies that grandmothered plans must end by December 31 – is exchange revenue a factor?
Yesterday, The Federalist published an article titled Five Easy Ways To Game Obamacare. It’s an interesting article, but we thought it might be helpful to add detail about some of the problems with the strategies mentioned. Gaming Obamacare may turn out to be more costly and difficult than you imagine. Buy nine, get three free The idea here is that… Read more about Gaming Obamacare isn’t as easy as it sounds
Open enrollment ended yesterday, but there are widespread extensions in most exchanges through the end of this week or even the end of the month in some states. Connect for Health Colorado shared a tweet and facebook update Sunday evening, clarifying that for anyone who had begun the enrollment process but didn’t have it finished by… Read more about Create a special enrollment period for those who file taxes after February 15 and owe a penalty
A couple years ago, I wrote a post about balance billing from out-of-network providers in emergency situations. Then a few days ago, we got an email from a reader who wondered if anything had changed since then, as her husband had been in a car accident and the emergency department physician was out-of-network, despite the ED… Read more about Out-of-network care, emergencies, and balance billing
Good news! The cost of Obamacare is less than we thought. Yesterday, the CBO released their comprehensive ten-year budget and economic outlook report. It’s 177 pages, and addresses all aspects of the federal budget and deficit, including Obamacare. Back in 2010, the CBO predicted that the the ACA would cost the federal government $759 billion in… Read more about Cost of Obamacare is 20% less than we thought
When the ACA was signed into law almost five years ago (time flies!), one of its cornerstones was the expansion of Medicaid in every state, to cover everyone with incomes up to 133% of the poverty level (plus a 5% income disregard, which essentially makes the threshold 138% of poverty). That was to be implemented… Read more about Expanding Medicaid was the right move in the 80s and still is today
The deadline to get a January 1 effective date has passed in Colorado and in most of the rest of the country (in six states you can still enroll and get coverage effective January 1). And that means that millions of people had their coverage automatically renewed on December 15. In the 37 states that… Read more about Open enrollment should continue into the new year – every year
It’s open enrollment time again, and happily, this one is certainly off to a better start than last year. The downside is that there’s only a month between the start of open enrollment and the December 15 enrollment deadline for people who need their new coverage to be effective January 1 (this is the case… Read more about The five improvements I’d make to the ACA and its implementation
Last Friday, the Supreme Court announced that they would hear King v. Burwell. That case is essentially the same as Halbig v. Burwell, and the two cases have been wending their way through the court system for quite a while. The crux of their argument is that the ACA only authorizes the government to give… Read more about Subsidies safe from King v Burwell in Colorado
Welcome to the Falling Leaves edition of the Health Wonk Review! Grab your pumpkin-flavored whatever and pull up a chair – we’ve got lots of good stuff from the health wonks this week. The election is coming – don’t forget to vote! – and so is open enrollment, so there’s lots to talk about when… Read more about Health Wonk Review – the falling leaves edition
Mark Udall and Cory Gardner are in a tight senate race right now, and one of the issues that has come up in several ads is contraception. Here’s what women in Colorado need to know about the two candidates and how their positions would impact our access to contraceptives: Udall supports the ACA. One of… Read more about Colorado’s Senate Candidates Mark Udall and Cory Gardner on Contraceptives
The Colorado Division of Insurance released 2015 health insurance rates this morning, and things are looking pretty good. The average increase across all carriers in the individual market is less than one percent: 0.71% to be exact. We’ve been in the health insurance industry since 2002, and we’ve certainly never seen an average even close… Read more about Average rates only increasing 0.71% in the Colorado individual market for 2015