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Last weekend, the House of Representatives passed the American Rescue Plan Act of 2021 (H.R. 1319), an economic stimulus package designed to provide relief from the impact of COVID-19 on Americans. The bill has the support of the majority of Americans – including those registered as Republicans and Independents.
H.R. 1319 is now under consideration in the Senate, so we don’t yet know exactly what will be included in the final legislation. But the health insurance provisions in the House version of the legislation are unchanged from what the House Ways and Means Committee had initially proposed, and have not been sticking points for the bill thus far.
Several provisions in H.R. 1319 are designed to make health coverage more accessible and affordable. Today we’re taking a look at how the legislation would change the ACA’s premium subsidy structure for 2021 and 2022, and the impact that would have on the premiums that Americans pay for individual and family health coverage.
If you’re among the 12 million people who purchase ACA-compliant coverage in the health insurance marketplaces, your coverage is likely to become more affordable under H.R. 1319.
What’s more, the Congressional Budget Office estimates that an additional 1.7 million people – most of whom are currently uninsured – would enroll in health plans through the marketplaces in 2022 as a result of the enhanced premium subsidies.
Some opponents of the legislation have criticized its premium subsidy enhancements as a handout to wealthy Americans. But that’s only because the legislation is designed to remedy the subsidy cliff – which can result in some households paying as much as half of their annual income for health insurance premiums. It’s a situation that’s obviously neither realistic nor sustainable for policyholders.
The Affordable Care Act (ACA) only provides premium tax credits (aka premium subsidies) if a household’s ACA-specific modified adjusted gross income doesn’t exceed 400 percent of the federal poverty level. For 2021 coverage in the continental U.S., that’s about $51,000 for a single person and $104,800 for a family of four. Depending on where you live, that might be a comfortable income – but not if you have to spend 20, 30, 40 or even 50 percent of that income on health insurance.
H.R. 1319’s adjustment to the premium tax credit guidelines would temporarily – for this year and next year – eliminate the income cap for premium subsidies. That means that – regardless of income – no one would have to pay more than 8.5 percent of their household income for the benchmark plan (the second-lowest-cost Silver plan available in the exchange in a given area).
Under this approach, subsidies would phase out gradually as income increases. Plan buyers would not be eligible for a subsidy if the benchmark plan’s full price wouldn’t be more than 8.5 percent of the household’s income. But in some areas of the country – and particularly for older applicants, who can be charged as much as three times the premiums young adults pay – premium subsidy eligibility could end up extending well above 400 percent of the poverty level.
In addition to addressing the subsidy cliff, H.R. 1319 also enhances premium subsidies for marketplace buyers who are already subsidy-eligible. The subsidies would get larger across the board, making after-subsidy premiums more affordable for most enrollees. At every income level, the legislation would reduce the percentage of income that people are expected to pay for the benchmark plan, which would result in larger subsidies.
How much larger? It would depend on location, income, and age. Let’s take a look at some examples.
We’ll consider applicants with various income levels and ages in three locations: Albuquerque, New Mexico – where premiums are among the nation’s lowest; Jackson, Mississippi – where premiums are close to the national average; and Cheyenne, Wyoming – where premiums are among the nation’s highest.
In each location, we’ll see how things would play out for a 25-year-old, a 60-year-old, and a family of four (45-year-old parents, and kids who are 13 and 10), all at varying income levels.
You can see the full comparison in this spreadsheet. (Current premiums were obtained via HealthCare.gov’s browsing tool. Premiums under H.R. 1319 were calculated using the proposed applicable percentage table in Section 9661(a) and the methodology outlined here, which would be unchanged under the new legislation.)
In most cases, you’ll notice that the subsidy amount is larger under H.R. 1319, resulting in a lower benchmark premium and also a lower price for the lowest-cost plan available to that applicant (or more plans available with no premium at all). This is because the new legislation specifically reduces the percentage of income that people have to pay for the benchmark plan. That, in turn, drives up the subsidy amounts that are necessary to reduce the benchmark premium. And since premium subsidies can be applied to any metal-level plan, it also results in a lower cost for the other available plans (or more premium-free plans, depending on the circumstances).
As you consider these numbers, note that if the current subsidy amount is $0, either the benchmark plan is already considered affordable for that person, or their income is over 400 percent of the poverty level and subsidies are simply not available. If the subsidy amount is $0 under the H.R. 1319 scenario, it means that the benchmark plan would not cost more than 8.5 percent of the applicant’s income.
As you can see, the additional subsidies would be widely available, but would be more substantial for people who are currently paying the highest premiums. Under the current rules, it may not be realistic for our Wyoming family to pay more than $30,000 in annual premiums (enrolling in the benchmark plan, with premiums in excess of $2,500 per month). The American Rescue Plan Act would bring their annual premiums for the benchmark plan down to under $10,000, which is much more manageable.
The legislation is not, however, a giveaway to wealthy Americans. If that family earned $500,000, they still wouldn’t get a premium subsidy under H.R. 1319, because even at $2,528/month, the full-price cost of the benchmark plan would only amount to 6 percent of their income. Unlike Medicare and the tax breaks for employer-sponsored health insurance, financial assistance with individual market health insurance would not extend to the wealthiest applicants.
By capping premiums at 8.5 percent of income, H.R. 1319 provides targeted premium assistance only where it’s needed. And by enhancing the existing premium subsidies, the legislation makes it easier for people at all income levels to afford health coverage.
Assuming these premium subsidy enhancements are approved by the Senate, they’ll be retroactive to the start of 2021. Current enrollees will be able to start claiming any applicable extra subsidy immediately, or they can wait and claim it on their 2021 tax return. The additional premium subsidies would also be available for 2022, but would no longer be available as of 2023 unless additional legislation is enacted to extend them.
And there’s currently a special enrollment period – which continues through May 15 in most states – during which people can sign up for coverage if they haven’t already. In most states, this window can also be used by people who already have coverage and wish to change their plan, so this is definitely a good time to reconsider your health insurance coverage and make sure you’re taking advantage of the benefits that are available to you.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
The post How the American Rescue Plan Act would boost marketplace premium subsidies appeared first on healthinsurance.org.
Edit: The Senate passed H.R.1319 on March 6, and the House passed the bill again on March 10. President Biden signed it into law on March 11. CMS published some initial information for marketplace enrollees on March 12.
Last weekend, the House of Representatives passed the American Rescue Plan Act of 2021 (H.R. 1319), an economic stimulus package designed to provide relief from the impact of COVID-19 on Americans. The bill has the support of the majority of Americans – including those registered as Republicans and Independents.
H.R. 1319 is now under consideration in the Senate, so we don’t yet know exactly what will be included in the final legislation. But the health insurance provisions in the House version of the legislation are unchanged from what the House Ways and Means Committee had initially proposed, and have not been sticking points for the bill thus far.
Several provisions in H.R. 1319 are designed to make health coverage more accessible and affordable. Today we’re taking a look at how the legislation would change the ACA’s premium subsidy structure for 2021 and 2022, and the impact that would have on the premiums that Americans pay for individual and family health coverage.
If you’re among the 12 million people who purchase ACA-compliant coverage in the health insurance marketplaces, your coverage is likely to become more affordable under H.R. 1319.
What’s more, the Congressional Budget Office estimates that an additional 1.7 million people – most of whom are currently uninsured – would enroll in health plans through the marketplaces in 2022 as a result of the enhanced premium subsidies.
Some opponents of the legislation have criticized its premium subsidy enhancements as a handout to wealthy Americans. But that’s only because the legislation is designed to remedy the subsidy cliff – which can result in some households paying as much as half of their annual income for health insurance premiums. It’s a situation that’s obviously neither realistic nor sustainable for policyholders.
The Affordable Care Act (ACA) only provides premium tax credits (aka premium subsidies) if a household’s ACA-specific modified adjusted gross income doesn’t exceed 400 percent of the federal poverty level. For 2021 coverage in the continental U.S., that’s about $51,000 for a single person and $104,800 for a family of four. Depending on where you live, that might be a comfortable income – but not if you have to spend 20, 30, 40 or even 50 percent of that income on health insurance.
H.R. 1319’s adjustment to the premium tax credit guidelines would temporarily – for this year and next year – eliminate the income cap for premium subsidies. That means that – regardless of income – no one would have to pay more than 8.5 percent of their household income for the benchmark plan (the second-lowest-cost Silver plan available in the exchange in a given area).
Under this approach, subsidies would phase out gradually as income increases. Plan buyers would not be eligible for a subsidy if the benchmark plan’s full price wouldn’t be more than 8.5 percent of the household’s income. But in some areas of the country – and particularly for older applicants, who can be charged as much as three times the premiums young adults pay – premium subsidy eligibility could end up extending well above 400 percent of the poverty level.
In addition to addressing the subsidy cliff, H.R. 1319 also enhances premium subsidies for marketplace buyers who are already subsidy-eligible. The subsidies would get larger across the board, making after-subsidy premiums more affordable for most enrollees. At every income level, the legislation would reduce the percentage of income that people are expected to pay for the benchmark plan, which would result in larger subsidies.
How much larger? It would depend on location, income, and age. Let’s take a look at some examples.
We’ll consider applicants with various income levels and ages in three locations: Albuquerque, New Mexico – where premiums are among the nation’s lowest; Jackson, Mississippi – where premiums are close to the national average; and Cheyenne, Wyoming – where premiums are among the nation’s highest.
In each location, we’ll see how things would play out for a 25-year-old, a 60-year-old, and a family of four (45-year-old parents, and kids who are 13 and 10), all at varying income levels.
You can see the full comparison in this spreadsheet. (Current premiums were obtained via HealthCare.gov’s browsing tool. Premiums under H.R. 1319 were calculated using the proposed applicable percentage table in Section 9661(a) and the methodology outlined here, which would be unchanged under the new legislation.)
In most cases, you’ll notice that the subsidy amount is larger under H.R. 1319, resulting in a lower benchmark premium and also a lower price for the lowest-cost plan available to that applicant (or more plans available with no premium at all). This is because the new legislation specifically reduces the percentage of income that people have to pay for the benchmark plan. That, in turn, drives up the subsidy amounts that are necessary to reduce the benchmark premium. And since premium subsidies can be applied to any metal-level plan, it also results in a lower cost for the other available plans (or more premium-free plans, depending on the circumstances).
As you consider these numbers, note that if the current subsidy amount is $0, either the benchmark plan is already considered affordable for that person, or their income is over 400 percent of the poverty level and subsidies are simply not available. If the subsidy amount is $0 under the H.R. 1319 scenario, it means that the benchmark plan would not cost more than 8.5 percent of the applicant’s income.
As you can see, the additional subsidies would be widely available, but would be more substantial for people who are currently paying the highest premiums. Under the current rules, it may not be realistic for our Wyoming family to pay more than $30,000 in annual premiums (enrolling in the benchmark plan, with premiums in excess of $2,500 per month). The American Rescue Plan Act would bring their annual premiums for the benchmark plan down to under $10,000, which is much more manageable.
The legislation is not, however, a giveaway to wealthy Americans. If that family earned $500,000, they still wouldn’t get a premium subsidy under H.R. 1319, because even at $2,528/month, the full-price cost of the benchmark plan would only amount to 6 percent of their income. Unlike Medicare and the tax breaks for employer-sponsored health insurance, financial assistance with individual market health insurance would not extend to the wealthiest applicants.
By capping premiums at 8.5 percent of income, H.R. 1319 provides targeted premium assistance only where it’s needed. And by enhancing the existing premium subsidies, the legislation makes it easier for people at all income levels to afford health coverage.
Assuming these premium subsidy enhancements are approved by the Senate, they’ll be retroactive to the start of 2021. Current enrollees will be able to start claiming any applicable extra subsidy immediately, or they can wait and claim it on their 2021 tax return. The additional premium subsidies would also be available for 2022, but would no longer be available as of 2023 unless additional legislation is enacted to extend them.
And there’s currently a special enrollment period – which continues through May 15 in most states – during which people can sign up for coverage if they haven’t already. In most states, this window can also be used by people who already have coverage and wish to change their plan, so this is definitely a good time to reconsider your health insurance coverage and make sure you’re taking advantage of the benefits that are available to you.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
The post How the American Rescue Plan Act will boost marketplace premium subsidies appeared first on healthinsurance.org.
Before we delve into this week’s news, a reminder that enrollment is now open for 2021 individual/family health insurance in every state except Idaho – but Idaho’s enrollment period will start on Monday. Uninsured people have another opportunity to sign up for coverage, and in most states, people who already have coverage can use this window as an opportunity to switch to a different plan if it would better meet their needs.
The Biden administration and the states that run their own exchanges are also pouring a great deal of money into marketing and outreach during this period, in an effort to reach the millions of uninsured Americans who don’t yet know about the coverage and financial assistance available to them via the marketplace or Medicaid. In most states, the enrollment window continues through May 15, but there are several states with different deadlines.
California S.B. 644, introduced last week, would help to connect unemployed California residents with health coverage resources, starting in July 2022. Under the terms of the legislation, the California Employment Development Department (EDD) would provide Covered California (the state-run exchange) with contact information for people who apply for programs administered by the EDD, including unemployment benefits, state disability, paid family leave, etc. Covered California would then reach out to these individuals, determine whether they’re eligible for Medi-Cal or premium subsidies, and help them get enrolled in coverage if they choose to do so.
In Maryland, a similar bill (H.B. 1002) would allow people seeking unemployment benefits to consent to having their contact information and other relevant information shared with Maryland Health Connection (the state-run exchange) and the Maryland Department of Health. These agencies could then determine whether the resident would be eligible for financial assistance with their health insurance, and help them enroll in coverage. Maryland already has an “easy enrollment” program that connects residents with the health insurance exchange via their tax returns; H.B.1002 would expand the outreach to include people dealing with the loss of a job.
On Monday, the Department of Justice asked the Supreme Court to scrap the oral arguments that are scheduled to be heard next month in a case to determine the legality of Medicaid work requirements. The case focuses on the work requirements in Arkansas and New Hampshire, but it would have ramifications for work requirements that the Trump administration approved in several other states as well.
Work requirements are not currently in effect in any state, and would not be compatible with the current rules that allow states to receive additional COVID-related federal Medicaid funding, on the condition that enrollees’ coverage not be terminated during the pandemic emergency period. But some states, including Arkansas, hope to eventually reimpose a Medicaid work requirement.
The Biden administration notified states earlier this month that the Medicaid work requirements that were approved over the last few years are now being reconsidered. Arkansas, which had the previous administration’s support in the work requirement lawsuit, filed a brief asking the Supreme Court to ignore the Department of Justice’s request and continue with the scheduled oral arguments next month. But Arkansas officials have also said that they will not seek reapproval for the work requirement when the current waiver expires at the end of this year, and are instead considering a work incentive program that would provide private coverage to people who participate in the program, and traditional Medicaid to those who don’t.
Virginia lawmakers have been working on a bill to create a reinsurance program in the state. But as has been the case in some other states that have considered reinsurance programs, there’s disagreement over how to cover the state’s portion of the funding.
The measure passed by Virginia’s House of Delegates earlier this month called for an assessment on individual/family and large group health plans in the state (but not small-group plans), set at 1% of the prior year’s premium revenue. But the Senate has proposed funding the state’s share of the reinsurance program – estimated at $40 to $60 million – from general fund revenues, without the need for an assessment on health insurers.
The two chambers are taking the measure into a conference committee, and have until March 1 to come to an agreement. Assuming they do reach an agreement, the reinsurance program is slated to take effect in 2023 – but it’s possible that the conference committee could work out an arrangement that allows it to take effect in 2022 instead. (Most other states that have established reinsurance programs have had them up and running by the plan year immediately following the enactment of legislation to start the program.)
Yesterday, Kentucky’s House of Representatives voted unanimously to pass H.B. 95, which would require state-regulated health plans to cap cost-sharing for insulin at $30/month, starting in 2022. The measure now heads to Kentucky’s Senate for further consideration. A similar bill – but with a cost-sharing limit of $100/month – passed in Iowa’s House of Representatives earlier this month.
A bill that would cap insulin cost-sharing at $50/month was introduced in California’s Senate last week. And although Illinois was one of the states that enacted legislation last year to cap insulin cost-sharing at $100/month, a new bill was introduced in the Illinois House last week that would lower that cap to $30/month. West Virginia also enacted a $100/month cap last year, but a new bill was introduced this month in West Virginia’s Senate that would lower the cap to $25/month.
In 2019, Colorado became the first state to enact legislation to limit cost-sharing for insulin. Several other states enacted similar legislation last year, and several more had already begun considering bills to limit cost-sharing for insulin earlier this year.
South Dakota Gov. Kristi Noem signed a bill last week that will allow the South Dakota Farm Bureau to offer health plans that will not be considered health insurance, and that will be specifically exempt from state and federal insurance laws and regulations. Tennessee, Kansas, Iowa, and Indiana already allow this type of plan to be sold.
South Dakota Farm Bureau noted that its plans to partner with a third-party administrator to offer the new plans. SDFB does intend to cover the Affordable Care Act’s essential health benefits, but it’s expected that that plan will use medical underwriting as a mechanism to keep costs down.
Oscar Health has filed to become a publicly traded company, with stock sales expected to begin next week. Oscar plans to offer 31 million shares, priced at $32 – $34 per share, potentially raising a billion dollars in the initial public offering. Shares will trade on the NY Stock Exchange under the ticker symbol OSCR.
Oscar offers health plans in 18 states this year. They have more than half a million members, most of whom are enrolled in individual/family plans obtained via the health insurance marketplaces. Although most insurers in the individual market struggled with losses in the early years of ACA implementation, many of them have since become profitable. But Oscar’s losses have continued to mount, despite steady expansion into new states and expansion into the Medicare Advantage market last year.
The Senate Health Committee held a hearing yesterday with California Attorney General Xavier Becerra, President Biden’s nominee to lead the Department of Health and Human Services. Another hearing takes place today, with the Senate Committee on Finance. The committees will then make a recommendation to the rest of the Senate, and the nomination will be sent to the full Senate for debate and a confirmation vote. If Becerra is confirmed, he would be the first Latino Secretary of Health and Human Services.
Becerra was previously in the U.S. House of Representatives from 1993 to 2017. He voted for the Affordable Care Act in 2009/10 and then voted to protect it numerous times over the ensuing years. Becerra became California’s Attorney General in 2017, taking over from Kamala Harris when she was elected to the Senate. He led numerous legal battles against the Trump administration, and some Senate Republicans have expressed opposition to his nomination.
Democrats and the White House have expressed confidence that Becerra will be confirmed. With the 50-50 split in the Senate, Becerra could be confirmed on a party-line vote, with Vice President Kamala Harris casting the tie-breaking vote. But moderate West Virginia Democrat Joe Manchin has indicated that he’s undecided on Becerra’s nomination. There are, however, moderate Republicans who may support Becerra’s confirmation.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
The post The Scoop: health insurance news – February 24, 2021 appeared first on healthinsurance.org.
Although open enrollment ended two months ago in most of the country, a new one-time enrollment opportunity is available for 2021 coverage. Uninsured Americans nationwide have access to this enrollment window, and in most states, it can also be used by people who want to pick a different plan or switch from off-exchange to on-exchange coverage.
This enrollment window – a response to the ongoing COVID emergency – is now underway nationwide, with the exception of Idaho, which announced on Monday that a special enrollment period would begin March 1. In almost every state, the enrollment period continues through May 15, although there are seven state-run exchanges that have – for now – different end dates:
If you’re not yet enrolled in health coverage for 2021, or if you’re enrolled in something like a short-term plan, Farm Bureau plan, or health care sharing ministry plan, this enrollment window – which does not require a qualifying event – is an opportunity to secure real health insurance coverage for the rest of the year.
And keep an eye on the COVID relief legislation that Congress is considering. It could end up providing enrollees with much larger and more widely available premium subsidies, making it particularly important that people get enrolled in on-exchange coverage before the end of this enrollment window.
Last week, the Biden administration began notifying states with approved Medicaid work requirements that CMS is considering withdrawing the approval for these programs. The letters were sent to Arizona, Arkansas, Georgia, Indiana, Nebraska, New Hampshire, Ohio, South Carolina, Utah, and Wisconsin, and clarify that CMS “has preliminarily determined that allowing work and other community engagement requirements to take effect … would not promote the objectives of the Medicaid program.”
There are currently no Medicaid work requirements in effect. Some have been overturned by the courts, some have been postponed voluntarily by the states, and others have been suspended or postponed due to the COVID pandemic and the ban on coverage terminations that states are required to adhere to in order to receive enhanced federal Medicaid funding during the pandemic. The Supreme Court will hear oral arguments next month in Arkansas v. Gresham, to determine whether the Trump administration’s approval of a Medicaid work requirement in Arkansas was lawful.
CMS also sent a letter (see Michigan’s here) last week to states that currently operate 1115 waivers, rescinding a previous letter that former CMS Administrator Seema Verma sent to states in early January. Verma’s letter had stated that if CMS were to terminate or withdraw approval for part or all of a state’s 1115 waiver, there would be a nine-month delay before the changes took effect.
Last week, we told you about a bill in South Dakota that would allow the state to join Tennessee, Kansas, Iowa, and Indiana in allowing Farm Bureau (or other agricultural organizations domiciled in the state for at least 25 years) to sell medically underwritten health plans that would specifically not be considered health insurance and thus would be exempt from insurance laws and regulations, including state laws as well as the Affordable Care Act’s rules.
The bill had already passed the Senate at that point, and has since passed in the South Dakota House as well. It’s now under consideration by GOP Gov. Kristi Noem, who consistently voted against the Affordable Care Act during her time in Congress.
There are other states where Farm Bureau partners with health insurers to offer ACA-compliant health insurance (Michigan is an example), and the Nebraska Farm Bureau partners with Medica to offer guaranteed-issue short-term health insurance during a limited annual enrollment period. But these approaches are not the same as allowing an agricultural organization to offer products that are specifically not considered health insurance.
Kansas is one of the states where the rules for short-term health plans are more restrictive than the current federal rules. But S.B. 199, introduced last week in the Kansas Senate, would change that. Kansas currently limits short-term health plans to a single renewal, which means their total duration cannot exceed 24 months. S.B. 199 would allow short-term health plans in Kansas to have total durations of up to 36 months – in line with current federal rules. The Biden administration may roll back the Trump-era rules for short-term plans, however, which would eventually make more relaxed state rules moot.
CVS Health/Aetna plans to offer health coverage in at least some health insurance exchanges during the open enrollment period that starts this November, although the insurer has not yet provided details in terms of where it will participate. Aetna had previously offered coverage in some exchanges, but had exited all of them by the end of 2017, and has not participated since. CVS/Aetna opting back into the exchanges would continue the trend that has been ongoing in 2019, 2020, and 2021, with insurers joining or rejoining the exchanges, after numerous insurers – including Aetna – left the exchanges in 2017 and 2018.
Aetna’s previous exit from the health insurance exchanges happened before the company was acquired by CVS. But the exit was controversial, and linked to the Department of Justice’s decision to block a merger between Humana and Aetna. Here’s what David Anderson wrote about this in 2016, and Charles Gaba has put together a timeline of Aetna’s 2016 decision-making process.
Washington state lawmakers are considering S.B. 5313, which would require state-regulated health plans to provide non-discriminatory coverage for medically necessary gender-affirming care. Insurers would not, for example, be able to deny coverage for services needed by transgender members, such as facial feminization, breast reductions, breast implants, etc. by classifying them as cosmetic procedures.
The bill was overwhelmingly approved last week by the Washington Senate’s Committee on Health and Long Term Care.
Legislation was introduced in Rhode Island last week that calls for the creation of a special legislative committee tasked with “a comprehensive study to determine the pros and cons of implementing a single-payer (health coverage) program in Rhode Island.” The legislation notes that an “improved Medicare-for-all type single-payer program” would be in the state’s best interest. There are not currently any states that have single-payer health coverage systems, although there are others that are considering similar studies.
Legislation has been introduced in several states this year that would create Medicaid buy-in programs. With the introduction of H.B. 2241, West Virginia is the latest state where lawmakers are considering this possibility. The idea is to create a public option program by allowing residents – who would not otherwise be eligible for Medicaid – to purchase Medicaid coverage as an alternative to purchasing private health insurance. There are not yet any states where Medicaid buy-in programs have been enacted; Nevada has come the closest, but the Medicaid buy-in legislation that lawmakers passed in 2017 was vetoed by Nevada’s governor.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
The post The Scoop: health insurance news – February 17, 2021 appeared first on healthinsurance.org.
In every state except Connecticut, Idaho, and Vermont, a COVID-related enrollment window will be open by next week. (In a few states, they’re already open.) During these enrollment windows, consumers can sign up for ACA-compliant health coverage without a qualifying event.
In most states, the enrollment window applies to anyone eligible to use the marketplace, including people who are already enrolled and want to make a plan change. But some of the state-run exchanges are limiting eligibility to only people who are currently uninsured, or to people who aren’t already enrolled through the exchange. And some states are extending the COVID-related enrollment window to off-exchange plans as well, although financial assistance is never available outside the exchange.
If you’re uninsured or know someone who is, this is an opportunity to have coverage in place for the rest of 2021, with an effective date as early as March 1. Millions of uninsured Americans are eligible for premium subsidies substantial enough to cover the full cost of at least some plans in the marketplace. And Congress is considering COVID relief measures (described below) that would make coverage even more affordable.
The House Ways and Means Committee unveiled a set of nine COVID relief proposals this week. Subtitle G, related to “promoting economic security,” includes several important health insurance provisions:
The House Energy and Commerce Committee also published its proposed COVID relief measures this week, including a provision that would provide additional financial incentives for the states to expand Medicaid eligibility if they haven’t already. There are still a dozen states that haven’t expanded Medicaid.
Under current rules, if and when they expand eligibility, the federal government will cover 90 percent of the cost for the newly eligible population, and will continue to fund the rest of the state’s Medicaid program at the state’s normal matching rate (varies from 50 percent to about 76 percent, depending on the state). But under the committee’s legislative proposal relating to Medicaid, states that newly expand Medicaid would get an additional 5 percent federal funding match for their whole Medicaid program, for the first two years of Medicaid expansion.
The committees will markup these proposals this week, and a floor vote in the House on the final COVID relief legislation is planned for later this month.
Legislation was introduced in Virginia last month to create a reinsurance program in the state. Last week, the Virginia House of Delegates passed the bill by a wide margin, and a Virginia Senate committee unanimously agreed to consider the bill during a special session that starts today.
If it’s passed and signed into law, the legislation calls for the state to submit a 1332 waiver proposal to the federal government by January 2022, and for the reinsurance program to be implemented by January 2023. (This is a fairly long timeline. We’ve seen several states implement reinsurance programs over the last few years, often with the program in place for the plan year immediately following the passage of the legislation that authorized it.)
Last week, we told you about a bill in Montana’s House that would prohibit on-exchange health plans in Montana from covering abortion services. On Friday, the bill passed in the House by a wide margin, and mostly along party lines. (Four Democrats voted yes, while one Republican voted no.) It’s now with the Montana Senate’s Judiciary Committee for further review. Montana is currently among the minority of states where abortion coverage can be provided under on-exchange plans and at least some plans do offer this coverage.
South Dakota’s Senate passed S.B.87 last week, which would allow a nonprofit agricultural organization, domiciled in the state for at least 25 years, to offer non-insurance health benefits to its members. The legislation, which was proposed by South Dakota Farm Bureau, would specifically exempt such health plans from insurance laws or oversight. Tennessee, Kansas, Iowa, and Indiana already allow Farm Bureau health plans to be sold with similar rules. (The plans are not considered health insurance and are thus not subject to insurance laws or regulations.)
The bill is now with the South Dakota House of Representatives, where the Agriculture and Natural Resources Committee approved it 11-1 this week, sending it to a vote on the House floor. The American Cancer Society has expressed strong opposition to the bill, noting that the proposed non-insurance health plans “have the potential of segmenting the insurance market, driving up premiums and making it harder for South Dakotans who live with serious or chronic disease to find health insurance.”
The concept of Medicaid buy-in as a way of establishing a public option has been debated for several years. Nevada lawmakers passed a Medicaid buy-in bill in 2017, but it was vetoed by the governor. Similar legislation was considered in New Mexico in 2019, but did not pass. (United States of Care has an extensive list of the actions that various states considered in 2019 related to Medicaid buy-in programs.)
This year, lawmakers in several states have introduced various forms of Medicaid buy-in legislation:
In 2018, the Trump administration relaxed the rules for association health plans (AHPS), allowing self-insured people to join AHPs, as well as small groups that share only a common geographical location. The rules would also have allowed for the creation of these associations for the sole purpose of offering health insurance, without any other business purpose. These rules were soon challenged in court, and vacated by a judge in 2019. The Trump administration appealed the decision, and oral arguments in the appeal were heard by the D.C. Circuit Court in November 2019.
But a ruling had not yet been handed down by the time the Biden administration took office, and the new administration soon asked the court to stay the appeal. The court granted that request this week, so the appeal is on hold while the new leadership at the Department of Labor reviews the case, with status reports due every two months.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
The post The Scoop: health insurance news – February 10, 2021 appeared first on healthinsurance.org.
Open enrollment for 2021 individual/family health plans ended weeks ago in most of the country, but it’s still ongoing in California, New Jersey, New York, and the District of Columbia. In all four areas, however, open enrollment ends this Sunday, January 31. After that, people in those areas will need a qualifying event in order to enroll, although New York’s COVID-related special enrollment period (details below) will still allow people who don’t have health insurance at all to enroll in coverage for another two months.
Although open enrollment has already ended in Maryland and Massachusetts, and will end in New York on Sunday, all three states have announced COVID-related special enrollment periods for uninsured residents, with the following deadlines:
It’s widely anticipated that the Biden administration will open a COVID-related special enrollment period via HealthCare.gov, with an executive order that’s expected to be signed tomorrow. Other state-run exchanges might then follow suit. In a recent letter to President Biden, several of them indicated they would like to coordinate with the federal government on this so as to create a unified national approach to reaching the remaining uninsured population. As Dave Anderson notes, an enrollment period at this time of the year might be easier for uninsured people to manage than the regular annual open enrollment period in the fall.
State legislators introduced SB1346 in Arizona’s Senate this week, calling for the removal of the state’s existing ban on abortion coverage for qualified health plans. Similar bills were introduced in Texas (SB448 and HB1362), and the Texas bills would also ensure that the state Medicaid program covers abortion services.
Last week, the Virginia Senate passed a similar bill by a vote of 20-17. Its companion bill, HB1896, passed in the House of Delegates this week, and the measure has now been sent to Gov. Ralph Northam for his consideration.
Hawaii does not prohibit qualified health plans from including abortion coverage, but new legislation introduced in Hawaii’s Senate would codify a requirement that individual and group insurers cover a variety of preventive and reproductive health benefits. The list of services that would have to be covered under the legislation includes many that are already required under the ACA (just in case the ACA is overturned by the Supreme Court), but also includes abortion services.
Democratic lawmakers in Connecticut’s House of Representatives have introduced legislation that would create a single-payer health coverage system in the state. It would include coverage for medical and prescription services as well as things like dental, vision, and long-term care, would be funded via taxes as opposed to premiums (plus pass-through funding from a 1332 waiver), and would have no cost-sharing (deductibles, copays, coinsurance).
That bill is a long shot; similar efforts in Vermont and Colorado failed over the last several years. But Connecticut is a state to watch this year in terms of health care reform legislation. Lawmakers have been pushing for a public option and are considering reinstating the health insurance tax that used to be assessed by the federal government, with the proceeds used to make health coverage more affordable. New Jersey used that approach and has used the revenue to create state-funded premium subsidies that are making coverage more affordable as of 2021.
More than a decade ago, Hawaii created the Hawaii Health Authority (HHA), tasked with developing a universal health coverage system for everyone on the Hawaiian Islands. But the HHA stalled when the Affordable Care Act came on the scene. With the COVID pandemic highlighting the cracks in the state’s current health coverage system (which is robust but highly linked to employment), advocates began pushing to revitalize the HHA and its mission.
Last week, Hawaii Representative Scott Saiki (D, District 26, and House Speaker) introduced legislation (HB192 and HB164) that would authorize and fund the HHA “to continue planning for the adoption of a universal, publicly-administered, healthcare-for-all insurance model with a single payout agency.”
Legislation was introduced last week in Virginia’s House of Delegates that calls for the state to create a reinsurance program and seek federal pass-through funding via a 1332 waiver. Fourteen states already have reinsurance programs – which tend to have fairly broad bipartisan support – and they are highly effective in terms of bringing down full-price premiums, making it easier for people who don’t get premium tax credits to afford individual health insurance. But lawmakers in some states have pushed back against reinsurance programs over the last few years, due to disagreements over how the state’s portion of the funding should be raised.
Acupuncture is not currently a state-mandated benefit in New York, nor is it covered under the state’s benchmark plan, upon which individual and small group plans must be based (some health plans in New York’s marketplace do voluntarily provide acupuncture benefits). A bill was introduced last week in New York’s Assembly that would require health insurance plans sold in the New York marketplace/exchange to cover acupuncture. If enacted, it would apply to any health plans issued or renewed on or after 90 days from the date of enactment.
Last year, New Mexico’s House passed legislation that would have created a state fee to replace the federal health insurance tax. The proceeds would have been directed to a new Health Care Affordability Fund, which would have been used to provide additional health insurance subsidies to New Mexico residents. The 2020 legislation did not advance in the Senate, so the measure died in last year’s legislative session.
But Gov. Michelle Lujan Grisham announced earlier this month that the Health Care Affordability Fund would be a legislative priority in 2021, and the legislation to get the ball rolling on this was introduced in New Mexico’s House of Representatives last week.
Over the last few years, voters in six states have approved Medicaid expansion ballot measures. As a result, Medicaid expansion has already taken effect in Maine, Idaho, Utah, and Nebraska, and will take effect this summer in Missouri and Oklahoma.
Of the dozen states that have still refused to expand Medicaid, only Florida, Mississippi, and South Dakota have constitutions that will allow Medicaid expansion via a ballot initiative. And advocates in all three states are working to get Medicaid expansion measures on the 2022 ballots.
Signatures were previously gathered for a ballot measure in Florida, but that effort was derailed in 2019. Advocates are hoping to revive the same ballot measure and continue collecting signatures this year. South Dakota’s ballot initiative and constitutional amendment were approved for circulation last fall, and signatures must be turned in by early November 2021. Advocates in Mississippi do not yet have their ballot initiative language finalized, but are hoping to begin gathering signatures this spring. Two bills have also been introduced in Mississippi to expand Medicaid legislatively, but they’re a long shot given the general opposition in the GOP-led legislature.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
The post The Scoop: health insurance news – January 27, 2021 appeared first on healthinsurance.org.
Q: Will my health insurance cover the costs of coronavirus testing and treatment?
A: The COVID-19 pandemic has drastically impacted the world over the last year. A common question that people have is “How will my health insurance cover the coronavirus?”
The short answer? It depends. With the exception of Original Medicare, health insurance differs greatly in the U.S., depending on where you live and how you obtain your coverage. Including the District of Columbia, there are 51 different sets of state insurance rules, separate rules that apply to self-insured group plans (which are not regulated by the states), and 51 different Medicaid/CHIP programs.
Nearly half of all Americans – including a large majority of non-elderly Americans – get their health coverage from an employer. Those plans are regulated by a combination of state and federal rules, depending on the size of the group and whether it’s self-insured or fully-insured.
And about 6 percent of Americans buy their own health insurance in the individual market, where both state and federal rules apply.
Under the terms of the Families First Coronavirus Response Act (H.R.6201), Medicare, Medicaid, and private health insurance plans – including grandfathered plans – are required to fully cover the cost of COVID-19 testing, without any cost-sharing or prior-authorization requirements, for the duration of the emergency period (which has most recently been extended through mid-April 2021). That includes the cost of the lab services as well as the provider fee at a doctor’s office, urgent care clinic, or emergency room where the test is administered.
Since it’s a federal law, the requirements apply to both self-insured and fully-insured health plans, whereas the testing coverage requirements that numerous states have imposed (see examples here and here) are only applicable to fully insured plans.
Health plans that aren’t considered minimum essential coverage are not required to cover COVID-19 testing under the federal rules. This includes short-term health plans, fixed indemnity plans, and healthcare sharing ministry plans. It also includes the Farm Bureau plans in Tennessee, Iowa, Indiana, and Kansas – which are not considered health insurance and are specifically exempt from insurance regulations. But some of these plans are voluntarily covering COVID-19 testing and telehealth, so the specifics depend on the plan.
States have the power to regulate short-term health plans, and Washington, for example, extended its testing coverage requirements to include short-term health plans. (Washington already has very strict rules for short-term health plans). But in most states, most plans that aren’t minimum essential coverage are not required to cover COVID-19 testing.
The CARES Act (H.R.748, enacted in March 2020) requires all non-grandfathered health plans, including private insurance, Medicare, and Medicaid, to cover COVID-19 vaccines without any cost-sharing for the member (the same caveats described above apply, however, as plans that aren’t regulated by the ACA are not included in the vaccine coverage requirement unless a state steps up and imposes its own requirement).
The full coverage of COVID-19 vaccines includes both the vaccine itself and any charges from the provider or facility for the administration of the vaccine. The COVID-19 vaccine has been added to the list of recommended vaccines, and the CARES Act required private health plans to begin fully covering it within 15 business days — much faster than the normal timeframe (which can be nearly two years, depending on the circumstances) between when a preventive care recommendation is made and when insurers have to cover it with no cost-sharing.
H.R.6201 allows states to use their Medicaid programs to cover COVID-19 testing for uninsured residents, and provides federal funding to reimburse providers for COVID-19 testing for uninsured patients. The CARES Act also provides funding to reimburse providers for the cost of administering COVID-19 vaccines to uninsured individuals.
It’s worth noting that people who don’t have minimum essential coverage are considered uninsured, so depending on availability, they would be eligible for covered testing and vaccines under these programs. In the weeks since the first COVID-19 vaccines were granted emergency use authorizations by the FDA, numerous state insurance departments have issued statements clarifying that residents will not have to pay for the vaccine, regardless of their insurance status.
Although the federal and state governments have stepped in decisively to ensure that most people won’t incur out-of-pocket costs for COVID-19 testing and vaccines, the cost of treatment is a different matter altogether.
Although the majority of patients are able to recover without hospitalization, Harvard’s Global Health Institute estimates that about 20 percent of COVID-19 patients need to be hospitalized, and about 20 percent of hospitalized patients will need intensive care, including ventilators.
Inpatient care, including intensive care, is an essential health benefit for all ACA-compliant individual and small group health plans (but states define exactly what’s covered for each essential health benefit, so the specifics do vary from one state to another). And although large group plans are not required to cover essential health benefits, they are required to provide “substantial” coverage for inpatient care. If they don’t, the employer can be subject to a penalty under the ACA’s employer mandate, but about 5 percent of large employers still opt to offer scanty plans that don’t comply with this regulation and would offer little in the way of coverage for COVID-19 treatment.
But even when it’s covered by insurance, inpatient care is expensive. And so is outpatient care, depending on the scope of the care that’s needed. This is where patients’ cost-sharing comes into play. Under the ACA, all non-grandfathered, non-grandmothered health plans must have in-network out-of-pocket maximums that don’t exceed $8,550 for a single individual in 2021 (this limit doesn’t apply to plans that aren’t regulated by the ACA, such as short-term health plans).
So for most patients who need COVID treatment in 2021, out-of-pocket costs won’t exceed $8,550. But that’s still a huge amount of money, and most people don’t have it sitting around. The majority of health plans have out-of-pocket limits well below that amount, but most people are still going to be on the hook for a four-figure bill if they end up needing to be hospitalized for COVID-19. Although employer-sponsored plans tend to be more generous than the plans people buy in the individual market, the average employer-sponsored plan still had an out-of-pocket maximum of $4,039 for a single employee in 2020.
With that said, however, many insurers around the country have opted to waive, at least temporarily, members’ out-of-pocket costs related to COVID-19 treatment. It’s important to understand, however, that if an insurer is acting as an administrator for a self-insured employer-sponsored plan, the employer would have to agree to waive the cost-sharing, as it’s the employer’s money (as opposed to the insurance company’s money) that pays the claims.
Some states (New Mexico and Massachusetts are examples) stepped up early in the pandemic and issued guidance requiring state-regulated insurers to cover treatment (as well as testing) with no cost-sharing, and others (Minnesota is an example) have strongly encouraged insurers to do so (note that the regulation in Massachusetts only applies to doctor’s offices, urgent care centers, and emergency rooms, but not to inpatient care). In addition, several states are requiring telehealth treatment with no cost-sharing. But for the most part, people who need extensive treatment for COVID-19 are going to have to meet their health plan’s deductible and likely the out-of-pocket maximum, unless the insurer has agreed to waive these costs.
Many states are encouraging or requiring state-regulated insurers to treat COVID-19 testing and treatment as in-network, regardless of whether the medical providers are in the plan’s network. And federal rules require this for the vaccine as well, with the cost fully covered regardless of whether the member gets the vaccine from an in-network or out-of-network provider. For vaccine administration, providers are generally not allowed to seek any payment from the patient, including via balance billing. But for COVID-19 testing and treatment provided by out-of-network medical providers, patients could still be subject to balance billing in some circumstances as the out-of-network provider doesn’t have to accept the insurance company’s payment as payment-in-full if it’s less than the billed amount.
And although H.R.6201 prohibits insurance plans from requiring prior authorization for testing, insurers are still allowed to impose their normal prior authorization rules for other services, including COVID-19 treatment, unless a state otherwise prohibits it on state-regulated plans.
So what can you do to protect yourself as much as possible in terms of your health insurance coverage during this pandemic? Here are a few pointers:
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
The post Will my health insurance cover the costs of coronavirus testing, vaccines, and treatment? appeared first on healthinsurance.org.
