The Scoop: health insurance news – February 3, 2021

February 3, 2021

In this edition

Special enrollment periods underway (or soon to be underway) in most states
House, Senate legislation would make ACA premium subsidies more generous
Maryland legislation would create young-adult subsidy pilot program
Minnesota legislation calls for transition to HealthCare.gov
Minnesota bill would require more robust coverage of outpatient mental health treatment
Washington legislation would create state-based premium subsidies
Mississippi and Kentucky consider extension of postpartum Medicaid coverage
Montana legislative committee advances bill to prohibit abortion coverage for on-exchange plans
More states consider bills that would cap out-of-pocket costs for insulin

Special enrollment periods underway (or soon to be underway) in most states

An executive order signed by President Biden has authorized a COVID-related special enrollment period on HealthCare.gov. The SEP will run from February 15 to May 15.

Last week, the Biden administration announced a special enrollment period for HealthCare.gov, which will run from February 15 to May 15. This window will allow anyone eligible to use the marketplace to enroll or make a plan change, without needing a qualifying event.

The SEP applies in the 36 states that use HealthCare.gov, but 12 of the other 15 state-run exchanges have also announced similar enrollment windows — some of which are already underway:

California: February 1 to May 15
Colorado: February 8 to May 15
DC: Through the end of the pandemic emergency period
Maryland: Through March 15
Massachusetts: Through May 23
Minnesota: February 16 to May 17
Nevada: February 15 to May 15
New Jersey: Through May 15
New York: Through March 31
Pennsylvania: February 15 to May 15
Rhode Island: Through May 15
Washington: February 15 to May 15

These state-run exchanges are taking a mixed approach to this enrollment window, with some allowing anyone to enroll, and others limiting it to only people who are currently uninsured. There are only three other states that run their own exchange platforms but have not yet announced COVID-related special enrollment periods: Connecticut, Idaho, and Vermont.

House, Senate legislation would make ACA premium subsidies more generous

Democrats in Congress have long been considering various proposals to enhance the ACA’s premium subsidies and make more robust coverage more affordable. Last month, Rep. Lauren Underwood (D-Ill.) introduced the Health Care Affordability Act (H.R. 369) and Sen. Mark Warner (D-Va.) introduced the Health Care Improvement Act of 2021. Both bills include the basic health care provisions that President Biden has proposed as part of his American Recovery Plan.

One of the most important aspects of these pieces of legislation is a fundamental change in the formula for calculating premium subsidies. Under these bills, the subsidies would become more generous, allowing more Americans to purchase coverage with minimal or zero premiums, and capping premiums at no more than 8.5 percent of income, regardless of a household’s income. At ACA Signups, Charles Gaba has created graphics that will help you visualize after-subsidy premiums as a percentage of income under the status quo versus H.R. 369, as well as a previous piece of federal legislation and California’s state-based subsidy system.

Maryland legislation would create young-adult subsidy pilot program

A bill (H.B. 780) introduced last week in Maryland calls for the state to create a pilot program that would provide state-funded premium subsidies to young adults with fairly low incomes. The legislation calls for the state to use $10,000,000 per year in 2022 and 2023 to provide additional premium assistance to people between the ages of 18 and 41, with incomes between 133 percent and 140 percent of the poverty level.

The ACA already provides federal premium subsidies for people at this income level, but the subsidies aren’t as strong for young people as they are for older enrollees. The pilot program would be designed to make net premiums more affordable and boost enrollment for this demographic.

Minnesota legislation calls for transition to HealthCare.gov

Minnesota H.F. 536 – introduced on Monday – calls for the state to transition away from MNsure as of 2022 and start utilizing HealthCare.gov instead. The measure is not likely to pass in the Minnesota House, given the Democratic majority in that chamber and the lawmakers’ general support for MNsure.

In 2017, former Gov. Mark Dayton vetoed a bill that would have transitioned the state to HealthCare.gov, and MNsure has continued to be a successful state-run exchange ever since.

Over the first few years the exchanges were in operation, several states shifted from their own enrollment platforms to HealthCare.gov (although Idaho took the opposite approach, switching from HealthCare.gov to their own platform as of the 2015 plan year). But the opposite trend has been ongoing for the last couple of years, with Nevada, Pennsylvania, and New Jersey all switching away from HealthCare.gov and operating their own exchange platforms, and other states planning to follow suit over the next few years. (You can see a full timeline of all the changes here.)

Minnesota bill would require more robust coverage of outpatient mental health treatment

Minnesota H.F. 415 and S.F. 377 – both introduced last week – would require major medical plans regulated by the state of Minnesota (ie, individual and fully-insured group plans, but not self-insured group plans) to cover a member’s first four outpatient mental health visits each year with cost-sharing that doesn’t exceed $25 per visit.

There’s no mention of an exclusion for HSA-qualified high-deductible health plans (HDHP), but that would need to be added to the legislation in order to allow HSA-compliant plans to continue to be available in Minnesota. IRS rules do not allow HDHPs to pay for services like mental health care until the member has met their deductible.

Washington legislation would create state-based premium subsidies

Washington state’s Cascade Care program, including standardized plans and public option plans, is underway this year. But part of the original 2019 Cascade Care legislation called for the state to develop a plan to provide state-based premium subsidies to people earning up to 500 percent of the poverty level.

Legislation to get the ball rolling on that did not advance in last year’s session, but a new bill was introduced last week with a similar intent. S.B. 5377 calls for the state to provide premium subsidies to people with income up to 500 percent of the poverty level (and possibly a cost-sharing assistance program), as long as they’re enrolled in the lowest-cost Bronze, Silver, or Gold standardized plan available in their area. Washington’s exchange conducted a detailed analysis of various approaches to state-based premium subsidy programs last year; their report includes a recommendation that the state-funded premium subsidies be provided as a fixed-dollar amount.

S.B. 5377 also addresses some aspects of the state’s existing public option program, including participation requirements for hospitals and surgical facilities, as well as a reduction in the reimbursement rate for hospitals (currently set at 160 percent of Medicare rates, but it would decline to 135 percent of Medicare rates under S.B. 5377, leading to lower premiums for enrollees).

Mississippi and Kentucky consider extending postpartum Medicaid coverage

Mississippi lawmakers are considering S.B. 2799, which would make a variety of changes to the state’s Medicaid program, including an extension of postpartum Medicaid coverage. Under current rules, a woman in Mississippi who qualifies for Medicaid due to pregnancy is eligible for 60 days of postpartum Medicaid coverage after the baby is born, but S.B. 2799 would extend that to 12 months (during the COVID pandemic, postpartum Medicaid coverage does not terminate after 60 days, due to the current rules that prevent states from terminating Medicaid coverage for any enrollees unless they move out of the state or request a coverage termination). Medicaid covers nearly two-thirds of all births in Mississippi — the highest proportion in the nation.

The Kentucky House Democratic Women’s Caucus has created a plan they’re calling the Kentucky Maternal and Infant Health Project, comprised of 21 proposed bills that would address a wide range of issues. Among them is a measure that would extend postpartum Medicaid coverage from 60 days to 12 months. The proposal also calls for pregnancy to be considered a qualifying event, which is currently only the case in New York, Connecticut, and DC.

Montana legislative committee advances bill to prohibit abortion coverage for on-exchange plans

Last week we told you about legislation in Arizona, Texas, and Virginia that would remove state rules that prohibit abortion coverage on health plans that are sold in the exchange/marketplace in those states. Montana lawmakers are considering the opposite approach, however, with H.B. 229. The bill, which was approved by the House Judiciary Committee last week, would prohibit abortion coverage on plans sold in the Montana exchange. The only exception would be in cases where the mother’s life is in danger.

Montana is currently one of a minority of states where there is no ban on abortion coverage for on-exchange plans, and at least one insurer does offer plans that include abortion coverage.

More states consider bills that would cap out-of-pocket costs for insulin

Last year, several states enacted legislation to cap consumers’ out-of-pocket costs for insulin. Other states are considering similar bills this year, including Montana ($35/month cap), Tennessee ($100/month cap), New Jersey ($50/month cap), and New York ($30/month cap; New York already passed a bill last year that limits out-of-pocket costs for insulin, but the cap is $100. The new legislation would reduce that to $30 instead).

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 3, 2021 appeared first on healthinsurance.org.

The Scoop: health insurance news – December 2, 2020

December 2, 2020

In this edition

Open enrollment ends in 13 days in most states
Oregon’s bipartisan congressional delegation asks HHS to extend open enrollment
Washington Healthplanfinder accepting public comments on standardized plan designs for 2022
Delaware fines insurers nearly $600,000 for mental health parity violations
Proposed health insurance rule changes include waiver allowing states to eliminate exchanges

Open enrollment ends in 13 days in most states

In most of the United States, open enrollment for individual/family health plans is scheduled to end in just 13 days – on December 15. If you haven’t yet figured out your health coverage for next year, now’s the time to get that done!

Our 2021 Open Enrollment Guide: Everything you need to know to enroll in an affordable individual-market health plan.

In 10 states and Washington, DC, the end of open enrollment has been extended, with deadlines that vary by state and continue well into January in some cases.

There are four other states (Connecticut, Idaho, Maryland, and Vermont) that run their own enrollment platforms and thus have the option to extend open enrollment if they choose to do so, although it’s still scheduled to end on December 15 in each of those states. In the rest of the country, the federal government runs the exchange and has control over the timing of open enrollment, currently slated to end December 15.

Oregon’s bipartisan congressional delegation asks HHS to extend open enrollment

Oregon’s entire bipartisan congressional delegation sent a letter to HHS this week, asking the federal government to extend the open enrollment period on HealthCare.gov. Oregon, like most of the rest of the country, relies on the HealthCare.gov enrollment platform, which means the state is unable to extend the enrollment deadline on its own.

The Oregon lawmakers pointed out that the COVID pandemic and this year’s devastating wildfires in Oregon are making it harder for people to enroll in health coverage for 2021 in a timely manner. They’re asking HHS to grant some extra flexibility by giving people until the end of December – instead of December 15 – to enroll in a health plan for 2021.

Washington Healthplanfinder accepting public comments on standardized plan designs for 2022

Washington State rolled out standardized plans in the individual market for the first time this fall. For the last month, some consumers in the state have been enrolling in these plans for 2021 coverage, but Washington’s exchange has already done much of the work to complete the standardized plan designs for 2022. They have publicized the draft plan designs, and are accepting public comments on the proposed plan designs through December 29. Comments can be emailed to standardplans@wahbexchange.org.

Delaware fines insurers nearly $600,000 for mental health parity violations

Delaware’s recently re-elected insurance commissioner, Trinidad Navarro, has imposed nearly $600,000 in fines for mental healthy parity violations by health insurers in the state. The Delaware Department of Insurance conducted a review of all four of the state’s major health insurers, checking for compliance with state and federal mental health parity requirements. (In general, the plan requirements and benefits provided for mental healthcare cannot be any more strict than the requirements and benefits that apply to other medical care.)

After finding “thousands” of violations, Delaware regulators worked with the insurers to remedy the problems and create more equitable access to mental health coverage and care in the state.

Proposed health insurance rule changes include waiver allowing states to eliminate exchanges

Last week, CMS published the proposed Notice of Benefit and Payment Parameters for 2022 (summary available here). Many aspects of the ACA were left up to HHS/CMS to implement and require ongoing adjustments, so CMS issues this rulemaking guidance each year. There’s a 30-day public comment period, and it appears that the Trump administration is hoping to finalize the proposed rules before the Biden administration takes over on January 20, 2021.

The proposed benefit and payment parameters cover a wide range of issues, as is always the case. But the following proposals are the ones that are most likely to directly affect you and your health insurance coverage:

Allow states to eliminate their exchanges: This is generally considered the most dramatic change that CMS has proposed for 2022, and it’s very similar to the waiver approval that it granted to Georgia last month. If finalized, this rule change would allow states to eliminate their central exchange (HealthCare.gov or a state-run exchange) and switch to a system of direct enrollment via brokers, agents, and insurers. Many people already enroll in on-exchange plans via the enhanced direct enrollment pathway, utilizing a third party’s website instead of the exchange website. But there are widespread concerns that consumers will fall through the cracks in states that opt to abandon their exchange platforms altogether – potentially having to visit multiple websites in order to get comprehensive information, not being able to learn about their eligibility for programs like Medicaid and CHIP, or being sold lesser quality coverage, such as short-term health insurance.
Maximum out-of-pocket increasing to $9,100: Under the ACA, health plans that aren’t grandfathered or grandmothered (or excepted from ACA rules altogether) must cap in-network out-of-pocket costs for their enrollees. But this cap changes each year, under a formula that has evolved over time. This year, the maximum out-of-pocket for a single person was $8,150. Next year, it will be $8,550. And for 2022, CMS has proposed a maximum out-of-pocket limit of $9,100. (The family cap is always double the individual amount.) Many plans will continue to have lower out-of-pocket caps, although catastrophic plans have the maximum allowable out-of-pocket exposure, as do most bronze plans.
More flexible SEP for people who lose eligibility for premium subsidies: Under current rules, a person who is receiving a premium subsidy (premium tax credit) qualifies for a special enrollment period if they become ineligible for that premium subsidy mid-year (either due to an income change or a change in household size), but they’re limited to picking a different plan at the same metal level as the plan they already have. CMS is proposing a more flexible special enrollment period that would also allow the option of switching to a plan at a lower metal level in order to give people the opportunity to reduce their monthly premiums as much as possible. Here are all the details.
New SEP when employer terminates contributions to COBRA premiums: In some cases, employers subsidize the cost of COBRA benefits for a certain period of time – this has been particularly common this year amid the widespread layoffs that stemmed from the COVID pandemic. When that subsidy ends, the full cost of the COBRA coverage can be unaffordable, but there’s not technically a special enrollment period for this situation, as it’s not among the official triggering events. CMS notes that people enrolling through HealthCare.gov have been granted a loss-of-coverage SEP in this situation, but the proposed rule change would add this as an official qualifying event for individual market coverage, making it applicable nationwide, both on-exchange and off-exchange.
New affordability threshold for catastrophic plan eligibility: People who are 30 and older can only buy a catastrophic plan if they have a hardship/affordability exemption from the exchange, indicating that the lowest-cost metal-level plan available to them would cost more than a certain percentage of their income. In 2020, that threshold is 8.24 percent. For 2022, CMS has proposed an increase to 8.47 percent.
MLR rebates: Earlier this year, to address the COVID pandemic, CMS issued guidance that allowed insurance companies to issue medical loss ratio (MLR) rebates earlier than usual. CMS is proposing a rule change that would essentially make this year’s relaxed rules permanent, allowing insurers the option to prepay MLR rebates rather than waiting until the fall to issue them.

At Health Affairs, Katie Keith has three detailed articles about the proposed benefit and payment parameters: One addressing rules related to the health insurance exchanges, a second addressing the MLR rules, and a third addressing the rules related to risk adjustment.

The post The Scoop: health insurance news – December 2, 2020 appeared first on healthinsurance.org.