Maddox Insurance Agency
  • Insurance Products
  • Get Your Quote
  • About
  • Insurance News
  • Contact
  • Home
  • Menu Menu

Biden administration announces three-month special enrollment period

January 28, 2021/in COBRA, executive order, health reform, open enrollment, special enrollment period /by wpmaddoxins

This morning, the White House announced that today, President Biden will sign two highly anticipated executive orders related to healthcare. The first is aimed at strengthening Medicaid and the Affordable Care Act, and will include a provision to create a COVID-related special enrollment period (SEP) on HealthCare.gov, for Americans who don’t currently have health coverage. State officials, insurers, and consumer advocates repeatedly asked the Trump administration for a COVID-related special enrollment period in 2020, but to no avail. (Almost all of the state-run exchanges did open COVID-related SEPs in 2020.)

When will the HealthCare.gov special enrollment period start?

The special enrollment period will run from February 15 to May 15, giving uninsured Americans three months in which to pick a health plan, even if they don’t otherwise have a qualifying event.

Who can use the COVID special enrollment period on HealthCare.gov?

This window is expected to be aimed at Americans who are uninsured, much like the COVID-related special enrollment periods that had already been announced in Maryland, Massachusetts, and New York. But the COVID-related SEP in Massachusetts also applies to people who have COBRA and would prefer to drop it and switch to a plan offered through the marketplace – it’s possible that the SEP on HealthCare.gov could be extended to populations like that as well.

Americans are technically considered uninsured if they have coverage under short-term health plans, Farm Bureau non-insurance plans, fixed indemnity plans, healthcare sharing ministry plans, direct primary care plans, and other similar types of coverage, since none of those are considered minimum essential coverage. So people with these types of coverage will be able to use the COVID special enrollment period on HealthCare.gov. And again, it’s also possible that this window could be extended to other groups as well, including those who have COBRA or state continuation coverage after a recent job loss.

Will state-run marketplaces also offer a special enrollment period for uninsured residents?

HealthCare.gov is used in 36 states, and the COVID SEP will apply in all of them. But it’s also likely that many of the state-run exchanges – in addition to Massachusetts, Maryland, and New York – could follow suit. Colorado’s exchange announced today that they’ll open a special enrollment period for uninsured residents, which will run from February 8 through May 15, and Washington’s exchange announced a special enrollment period, with the same dates that HealthCare.gov will use, for “anyone seeking health insurance coverage.”

Last month, insurance commissioners from 11 states sent a letter to President Biden, encouraging him to take various actions to improve access to health coverage and care. Opening a special enrollment period was among their recommendations, along with “restoring outreach funding, restoring flexibility on eligibility rules like failure to reconcile, and immediately revoking public charge rules.”

The insurance commissioners who wrote the letter – six of whom represent states that run their own exchanges (California, Colorado, Minnesota, Pennsylvania, Rhode Island, and Washington) – further noted that

“many of our states run our own state-based marketplaces and we would like to work with you to ensure that any effort to encourage marketplace enrollment is truly national and therefore inclusive of state-based marketplaces, in addition to HealthCare.gov. We ask you, as soon as possible, to coordinate with state-based marketplaces on the timing of any SEP, the messaging you intend to use, and key strategies you will employ to reach the uninsured so that we can align our plans with yours.”

So it’s quite likely that many of the remaining state-based marketplaces will open COVID-related SEPs this spring, allowing uninsured residents another opportunity to sign up for health coverage.

How can I get coverage between now and February 15?

If you’re uninsured and not in one of the states where open enrollment for 2021 plans is ongoing until the end of January, your options for getting coverage before the new special enrollment period will be limited.

But you likely do still have at least some options, as outlined here. If you’re eligible for Medicaid or CHIP, enrollment continues year-round, with coverage that can take effect immediately or even retroactively. Otherwise, you may have to consider a plan that’s not regulated by the Affordable Care Act, such as a short-term plan or health care sharing ministry, to tide you over until you can enroll in a plan through the marketplace.

What else will the executive orders do?

The special enrollment period for uninsured Americans is generating headlines and will be available in just a couple of weeks. But the executive order is expected to direct federal agencies to consider a variety of other reforms, which could have far more significant impact.

Among the most likely are

  • restoring funding for navigators and the outreach/education work that HealthCare.gov was able to do under the Obama administration,
  • rolling back the Trump administration’s relaxed rules for short-term health plans (in order to protect people with pre-existing conditions),
  • no longer approving Medicaid work requirements, rolling back the relaxed guardrails for 1332 waivers that the Trump administration championed,
  • changing the way affordability of employer-sponsored plans is calculated (in order to fix the family glitch), and
  • possible solutions that would eliminate the subsidy cliff and make coverage more affordable for people with income a little above 400 percent of the poverty level.

The second executive order will be aimed at protecting women’s health in America and around the world, including ensuring access to all necessary reproductive health care. It’s expected to rescind the global gag rule (Mexico City Policy), which blocks U.S. funding for international non-profits that provide women with abortion counseling or referrals. The rule was first implemented in the 80s and has been rescinded and reinstated several times under different administrations.

It’s also expected that the women’s health executive order will direct federal agencies to reconsider the Trump administration rule that eliminated federal funding for Planned Parenthood and other abortion providers.


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 Biden administration announces three-month special enrollment period appeared first on healthinsurance.org.

https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png 512 512 wpmaddoxins https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.png wpmaddoxins2021-01-28 13:54:242021-01-28 14:01:14Biden administration announces three-month special enrollment period

Biden administration announces COVID-related special enrollment period

January 28, 2021/in Blog, COBRA, executive order, health reform, open enrollment, special enrollment period /by wpmaddoxins

Today, President Biden signed two highly anticipated executive orders related to healthcare. The first is aimed at strengthening Medicaid and the Affordable Care Act, and directs HHS to consider creating a COVID-related special enrollment period (SEP) on HealthCare.gov. The Biden administration has also committed $50 million to outreach and education, in order to make people aware of the enrollment opportunity and the extensive financial assistance that’s available to help offset the cost of coverage and care.

State officials, insurers, and consumer advocates had repeatedly asked the Trump administration for a COVID-related special enrollment period in 2020, but to no avail. (Almost all of the state-run exchanges did open COVID-related SEPs in 2020.)

When will the HealthCare.gov special enrollment period start?

The special enrollment period runs from February 15 to August 15, giving people six months in which to pick a health plan, even if they don’t otherwise have a qualifying event (edit: this is an extension; the window was initially slated to end May 15, 2021, but was subsequently extended to August 15).

Who can use the COVID special enrollment period on HealthCare.gov?

Anyone who is eligible to use the marketplace can enroll during this special enrollment period. This includes people who are uninsured, under-insured, or already enrolled in a plan through the marketplace and wanting to switch to a different plan.

Previously, it was expected that this new special enrollment window would be aimed at Americans who are uninsured, much like the COVID-related special enrollment periods that had already been announced in the District of Columbia, Maryland, Massachusetts, and New York (the SEP in Massachusetts also applies to people who have COBRA and would prefer to drop it and switch to a plan offered through the marketplace). But when CMS published the details of the SEP, it was clear that they wanted to cast a wide net, making the special enrollment period available for those who are without coverage, but also for current marketplace enrollees.

They’ve clarified that “current enrollees will be able to change to any available plan in their area without restriction to the same level of coverage as their current plan.” They also note that “consumers won’t need to provide any documentation of a qualifying event (e.g., loss of a job or birth of a child), which is typically required for SEP eligibility.”

So regardless of whether you’ve got no coverage at all, are already enrolled in a plan through HealthCare.gov, or have coverage under something like a short-term health plan, Farm Bureau non-insurance plan, fixed indemnity plan, healthcare sharing ministry plan, direct primary care plan, or other similar types of coverage, you’ll be able to use HealthCare.gov to sign up for coverage during this window.

Are state-run marketplaces also offering a special enrollment period for uninsured residents?

HealthCare.gov is used in 36 states, and the COVID SEP applies in all of them. But all of the state-run exchanges have followed suit (in addition to DC, Massachusetts, Maryland, and New York, which had already announced COVID-related special enrollment periods). Here’s a summary of the COVID-related special enrollment periods in states that run their own exchanges (note that this list has been updated over time, as more state-run exchanges announce special enrollment periods):

  • California: February 1 to May 15
  • Colorado: February 8 to May 15
  • Connecticut: February 15 to April 15
  • DC: Through the end of the pandemic emergency period
  • Idaho: March 1 to March 31
  • Maryland: Through May 15 (retroactive coverage is available, depending on when a person enrolls)
  • Massachusetts: Through July 23
  • Minnesota: February 16 to May 17
  • Nevada: February 15 to May 15
  • New Jersey: Through May 15
  • New York: Through May 15
  • Pennsylvania: February 15 to May 15
  • Rhode Island: Through May 15
  • Vermont: February 16 to May 14
  • Washington: February 15 to May 15

Some of these enrollment windows apply only to uninsured residents, while others apply to anyone eligible to use the marketplace, including people who already have coverage and want to switch to a new plan.

Last month, insurance commissioners from 11 states sent a letter to President Biden, encouraging him to take various actions to improve access to health coverage and care. Opening a special enrollment period was among their recommendations, along with “restoring outreach funding, restoring flexibility on eligibility rules like failure to reconcile, and immediately revoking public charge rules.”

The insurance commissioners who wrote the letter – some whom represent states that run their own exchanges – further noted that

“many of our states run our own state-based marketplaces and we would like to work with you to ensure that any effort to encourage marketplace enrollment is truly national and therefore inclusive of state-based marketplaces, in addition to HealthCare.gov. We ask you, as soon as possible, to coordinate with state-based marketplaces on the timing of any SEP, the messaging you intend to use, and key strategies you will employ to reach the uninsured so that we can align our plans with yours.”

And the CMS press release notes that the administration “strongly encourages states operating their own Marketplace platforms to make a similar enrollment opportunity available to consumers in their states.” As of early February, only three state-run exchanges had not announced COVID-related special enrollment periods (edit: all three had announced COVID-related enrollment periods by mid-February; there are COVID-related enrollment periods nationwide, although the rules and deadlines vary a bit in some states).

How can I get coverage after the COVID-related enrollment period ends?

If you’re uninsured and don’t enroll during the COVID-related enrollment period in your state, your options for getting coverage for the remainder of 2021 will be limited.

But you likely do still have at least some options, as outlined here. If you’re eligible for Medicaid or CHIP, enrollment continues year-round, with coverage that can take effect immediately or even retroactively. Otherwise, you may have to consider a plan that’s not regulated by the Affordable Care Act, such as a short-term plan or health care sharing ministry, to tide you over until you can enroll in a plan through the marketplace.

What else will the executive orders do?

The special enrollment period for uninsured Americans is generating headlines and will be available in just a couple of weeks. But the executive order is expected to direct federal agencies to consider a variety of other reforms, which could have far more significant impact.

Among the most likely are

  • restoring funding for navigators and the outreach/education work that HealthCare.gov was able to do under the Obama administration,
  • rolling back the Trump administration’s relaxed rules for short-term health plans (in order to protect people with pre-existing conditions),
  • no longer approving Medicaid work requirements or block grant proposals,
  • rolling back the relaxed guardrails for 1332 waivers that the Trump administration championed,
  • changing the way affordability of employer-sponsored plans is calculated (in order to fix the family glitch), and
  • possible solutions that would eliminate the subsidy cliff and make coverage more affordable for people with income a little above 400 percent of the poverty level.

The second executive order is aimed at protecting women’s health in America and around the world, including ensuring access to all necessary reproductive health care. It rescinded the global gag rule (Mexico City Policy), which blocked U.S. funding for international non-profits that provide women with abortion counseling or referrals. The rule was first implemented in the 80s and has been rescinded and reinstated several times under different administrations.

The women’s health executive order also directs federal agencies to reconsider the Trump administration rule that eliminated federal funding for Planned Parenthood and other abortion providers.


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 Biden administration announces COVID-related special enrollment period appeared first on healthinsurance.org.

https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png 512 512 wpmaddoxins https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.png wpmaddoxins2021-01-28 13:54:242021-03-24 15:00:04Biden administration announces COVID-related special enrollment period

The Scoop: health insurance news – January 27, 2021

January 27, 2021/in abortion, covid-19, health reform, open enrollment, public option, Reinsurance /by wpmaddoxins

In this edition

  • Open enrollment ends Sunday in California, New York, New Jersey, and Washington, DC
  • Maryland, Massachusetts, New York announce COVID-related SEPs for uninsured residents
  • Legislation introduced in Arizona and Texas would remove ban on abortion coverage for qualified health plans; similar bill passed in Virginia
  • Connecticut lawmakers introduce single-payer bill amid push for public option, reinstatement of health insurance tax
  • Legislation introduced in Hawaii would continue progress toward single-payer system
  • Virginia lawmakers introduce legislation to create reinsurance program
  • Legislation introduced in New York would require marketplace plans to cover acupuncture
  • New Mexico lawmakers again consider Health Care Affordability Fund
  • Florida, Mississippi, South Dakota voters may see Medicaid expansion ballot initiatives in 2022

Open enrollment ends Sunday in California, New York, New Jersey, and Washington, DC

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.

Maryland, Massachusetts, New York announce COVID-related SEPs for uninsured residents

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:

  • Maryland: March 15, 2021
  • Massachusetts: March 23, 2021 (This also applies to people who have COBRA and would prefer to switch to an individual/family plan instead of exhausting their COBRA coverage.)
  • New York: March 31, 2021

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.

Legislation introduced in Arizona and Texas would remove ban on abortion coverage for qualified health plans; similar bill passed in Virginia

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.

Connecticut lawmakers introduce single-payer bill amid push for public option, reinstatement of health insurance tax

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.

Legislation introduced in Hawaii would continue progress toward single-payer system

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.”

Virginia lawmakers introduce legislation to create reinsurance program

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.

Legislation introduced in New York would require marketplace plans to cover acupuncture

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.

New Mexico lawmakers again consider Health Care Affordability Fund

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.

Florida, Mississippi, South Dakota voters may see Medicaid expansion ballot initiatives in 2022

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.

https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png 512 512 wpmaddoxins https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.png wpmaddoxins2021-01-27 14:10:152021-01-28 14:01:14The Scoop: health insurance news – January 27, 2021

The Scoop: health insurance news – January 20, 2021

January 20, 2021/in Biden, COBRA, health reform, Medicaid work requirements, open enrollment, premium subsidies /by wpmaddoxins

In this edition

  • President Biden’s American Recovery Plan calls for additional premium subsidies and COBRA subsidies
  • Open enrollment for 2021 coverage ends Saturday in Massachusetts and Rhode Island
  • Partial 2022 health insurance rules finalized by outgoing Trump administration
  • Lawsuit filed to block Georgia’s plan to eliminate its health insurance exchange
  • Bills introduced in Virginia to eliminate current ban on abortion coverage on marketplace plans, and study infertility coverage mandate
  • Legislation introduced in Maryland and Rhode Island to create universal health care commissions
  • Legislation introduced in Missouri calls for a Medicaid work requirement as of 2022
  • Uncompensated care funding in Florida and Texas extended through 2030

President Biden’s American Recovery Plan calls for additional premium subsidies and COBRA subsidies

Newly inaugurated President Joe Biden outlined his American Recovery Plan last week, and it includes some important provisions aimed at improving access to health coverage. The wide-ranging $1.9 trillion proposal, which would have to be approved by Congress, calls for premium tax credits to be increased “to lower or eliminate health insurance premiums” and to cap any enrollee’s after-subsidy premium at no more than 8.5 percent of their income. This second provision would primarily help people with income near or a little above 400 percent of the poverty level, and could make a substantial difference in the affordability of coverage for some households that currently have to pay full-price for their coverage — sometimes amounting to well over a quarter of their income.

The plan also calls for government subsidies of COBRA premiums through the end of September 2021. In 2009, the American Recovery and Reinvestment Act provided COBRA subsidies, which could serve as a model for how a new round of COBRA subsidies might work.

Biden’s American Recovery Plan encompasses far more than just health coverage. But if you’re curious about how health care reform might proceed under the new administration and the new Congress, check out this two-part series from Andrew Sprung, this piece from Charles Gaba, and this piece from Katie Keith.

Open enrollment ends Saturday in Massachusetts and Rhode Island

Open enrollment for 2021 health coverage is still ongoing in five states and Washington, DC (plus a COVID-related special enrollment period for uninsured residents in Maryland). But the enrollment window ends this Saturday, January 23, in Massachusetts and Rhode Island. After Saturday, residents in those states will need a qualifying event in order to enroll or make changes to their 2021 coverage.

As of this week, confirmed marketplace enrollment totals for 2021 coverage have surpassed 11.6 million nationwide.

Partial 2022 health insurance rules finalized by outgoing Trump administration

Last fall, the Trump administration published the proposed Notice of Benefit and Payment Parameters for 2022. This annual rulemaking document is wide-ranging and typically addresses a variety of issues related to the health insurance exchanges, special enrollment periods, risk adjustment, etc. At the time, we summarized several of the proposed rule changes that were most likely to directly affect people with individual market health plans.

Last week, the Trump administration announced that it was finalizing some aspects of the proposal — including the most controversial ones — but that the rest of the proposed rule changes would be finalized in an additional rule that will be issued “at a later date.” That will be under the Biden administration, which is also likely to delay the rule the Trump administration finalized last week (currently slated to take effect March 15) and reissue a new proposed rule, with a new comment period.

A total of 542 comments were submitted to CMS regarding the proposed rule changes for 2022. The comments that pertain to the rule changes that CMS finalized last week are summarized in the final rule, along with the responses from CMS. Notably:

  • Although CMS noted that “nearly all commenters on this rulemaking cautioned about potential harmful impacts to consumers” of allowing states to abandon their exchanges and rely entirely on brokers, agents, and insurers for health plan enrollment, the proposed rule change that would allow this was finalized. There would still be a role for an official exchange website in states that choose this option, but it would be minimal. And there are ongoing concerns that a switch to relying on brokers, agents, and insurers, instead of exchanges, will make it harder for Medicaid-eligible enrollees to understand the assistance and coverage that’s available to them.
  • The Trump administration’s 2018 guidance on 1332 waivers, which sharply relaxed the “guardrails” that apply to these waivers, is being officially incorporated into federal regulations.
  • The fee that insurers pay HealthCare.gov (and pass on to consumers via premiums) will be reduced in 2022. In states that rely fully on HealthCare.gov, it will be 2.25 percent of premiums; in states that run their own exchanges but use HealthCare.gov for enrollment, it will be 1.75 percent of premiums (down from a current 3 percent and 2.5 percent, respectively).

Many of the proposed rule changes are still under consideration and were not finalized last week, including the premium adjustment percentage (which would affect maximum out-of-pocket amounts and the affordability threshold for catastrophic plan eligibility), special enrollment periods when employer COBRA subsidies cease or a person loses eligibility for premium subsidies, and a rule change that would permanently allow insurers to issue MLR rebates earlier in the year.

At Health Affairs, Katie Keith has an excellent in-depth analysis of the partial final rule.

Lawsuit filed to block Georgia’s plan to eliminate its health insurance exchange

Last fall, the Trump administration approved Georgia’s 1332 waiver proposal to transition away from HealthCare.gov and instead utilize a system that relies on brokers, agents, and insurers to get people enrolled, without a centralized exchange (the finalized rule change that allows a similar approach nationwide is very reminiscent of Georgia’s 1332 waiver).

Last week, Planned Parenthood Southeast and Feminist Women’s Health Center filed a lawsuit against HHS, CMS, the Department of the Treasury, and their respective leaders, alleging that the waiver was unlawfully approved and should be vacated. Democracy Forward, which is representing the plaintiffs in the case, explained that Georgia’s 1332 waiver “will do immense damage to Georgia’s health insurance market, force Georgians to shop for insurance through private brokers and insurance companies, lead more residents to enroll in junk plans, and increase premiums.”

Bills introduced in Virginia to eliminate state ban on abortion coverage under marketplace plans; study impact of mandating coverage for infertility

Virginia is one of 26 states where health insurance plans sold in the marketplace/exchange are not allowed to provide coverage for abortions. (Virginia’s ban includes exceptions for abortion coverage in cases of rape, incest, or the mother’s life being in danger.) Legislation was introduced last week in Virginia’s Senate that would eliminate this ban, allowing insurers to offer abortion coverage if they choose to do so.

Legislation has also been introduced in Virginia that would direct the Virginia Health Insurance Reform Commission to conduct a study on the impacts of requiring health insurance plans in the state to cover infertility treatment. There are currently 19 states that mandate at least some coverage for infertility treatment.

Legislation introduced in Maryland and Rhode Island to create universal healthcare commissions

Legislation was introduced in Maryland last week that calls for the state to create a Commission on Universal Health Care. The Commission would be tasked with developing a plan for the state to establish a single-payer universal coverage system by 2024.

Legislation was also introduced in Rhode Island last week that calls for the creation of a special legislative commission that would study how the state might go about implementing a single-payer Medicare-for-All type of health coverage program in Rhode Island.

Legislation introduced in Missouri to create a Medicaid work requirement

Missouri has not yet expanded Medicaid eligibility under the ACA, but that will change this summer, thanks to a ballot initiative that voters in the state passed last year. Legislation was introduced this month in Missouri’s Senate that calls for a Medicaid work requirement in the state, effective as of January 2022. Under the terms of the bill, non-exempt Medicaid enrollees would have to work (or participate in various other community engagement activities, including volunteering, school, job training, etc.) at least 80 hours per week in order to maintain eligibility for Medicaid.

The Trump administration approved numerous work requirement waivers over the last few years, but due to lawsuits and the COVID pandemic, none are currently in effect. And the Biden administration is very unlikely to approve any additional waivers, meaning that Missouri’s legislation is likely a non-starter for the time being, even if it’s enacted.

Uncompensated care funding in Florida and Texas extended through 2030

Last Friday, the Trump administration renewed 1115 waivers in Texas and Florida, both of which are now valid through mid-2030. These waivers are for Medicaid managed care, and also provide federal funding for uncompensated care – which is more of a problem in states like Texas and Florida, due to their failure to expand Medicaid and the resulting coverage gap for low-income residents.


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 20, 2021 appeared first on healthinsurance.org.

https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png 512 512 wpmaddoxins https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.png wpmaddoxins2021-01-20 12:58:272021-01-20 14:26:31The Scoop: health insurance news – January 20, 2021

The Scoop: health insurance news – January 13, 2021

January 13, 2021/in covid-19, health reform, Medicaid block grants, open enrollment, short term health insurance, The Scoop /by wpmaddoxins

In this edition

  • Open enrollment for 2021 coverage ends Friday in CO, CT, PA, NV, and WA
  • Exchange enrollment has already surpassed last year’s total
  • HHS extends public health emergency through mid-April
  • Tennessee’s Medicaid block grant waiver approved
  • CMS auditing hospitals for compliance with new price transparency requirements
  • Legislation in Minnesota would expand MinnesotaCare, create a public option
  • Utah Insurance Department proposes new minimum standards for short-term health plans
  • BCBS Association suspends contributions to members of Congress who voted to reject electoral college results

Open enrollment for 2021 health plans will end in five states on Friday

Open enrollment for individual/family health plans ended a month ago in most of the country, but it’s still underway in ten states and Washington, DC. In five of those states, there are only a few days left. Open enrollment ends this Friday, January 15, in five states:

  • Colorado
  • Connecticut
  • Pennsylvania
  • Nevada
  • Washington

Residents in those states can currently enroll in a plan with a February 1 start date. But after Friday, enrollment in those states will only be possible for people who experience a qualifying event (and most qualifying events require that the person already had minimum essential coverage within the prior 60 days).

Exchange enrollment has already surpassed last year’s total

As of January 12, confirmed enrollment in individual market plans via the exchanges stood at 11.5 million, according to Charles Gaba of ACA Signups. And open enrollment is still ongoing in ten states and Washington, DC (plus a special enrollment period for uninsured Maryland residents). What’s more, four states – Idaho, New York, Rhode Island, and Vermont – haven’t yet reported any of their enrollment data for 2021 plans.

Last year, when all was said and done, enrollment reached 11.4 million, so it’s already surpassed the 2020 total – the first time since 2016 that year-over-year enrollment has grown during the open enrollment period. Once open enrollment closes in all states and final data are reported, Gaba projects that this year’s enrollment will exceed 12 million.

HHS extends COVID public health emergency through mid-April

Last week, HHS Secretary Alex Azar announced that the COVID-19 public health emergency was being extended for another 90 days, through April 21, 2021. The ongoing public health emergency – which was first declared in January 2020 and extended several times since then – plays a key role in various rules related to health insurance coverage.

For the duration of the emergency period, for example, most health insurance plans must cover the cost of COVID testing and vaccines without cost-sharing. States will continue to receive additional federal matching funds for Medicaid through June 2021, and cannot disenroll people from their Medicaid programs during the COVID emergency period, unless the person moves out of state or requests a coverage termination. The public health emergency also expands access to telehealth and reduces reporting burdens for hospitals.

Tennessee’s Medicaid block grant waiver approved

In November 2019, Tennessee submitted a waiver proposal to CMS, seeking approval to transition to a block grant funding approach for the state’s Medicaid program. Last week the Trump administration announced that the state’s proposal had been approved for 10 years, with the extended timeframe intended to “reduce administrative burden and allow the state sufficient time to evaluate its innovative approach.” Instead of the open-ended matching system that the federal government uses with the rest of the states, Tennessee will have an annual spending cap, which can grow if enrollment grows, but which will not adjust to keep up with increasing healthcare spending.

In its approval letter, the Trump administration repeatedly touts the flexibility that the block grant waiver will provide for Tennessee. But block grants for Medicaid funding have been widely panned by public health experts, and are strongly opposed by leading patient advocacy groups due to the potential for reduced benefits, increased costs for enrollees, reductions in payments to providers, and state budget shortfalls.

Although the incoming Biden administration can make changes to 1115 waivers via a review process, Margo Sanger-Katz reported last week that CMS has sent letters to all 45 states that have active waivers, asking them to sign contracts that would make it harder for a new administration to terminate waivers “on a political whim.”

CMS auditing hospitals for compliance with new price transparency requirements

The hospital price transparency rule that CMS finalized in late 2019 took effect on January 1. It requires hospitals to “provide clear, accessible pricing information online” for 300 “shoppable” services, in both machine-readable and consumer-friendly formats. And the pricing information has to include payer-specific negotiated rates, which is much more useful than hospital “chargemaster” rates that don’t really reflect the amounts that payers and consumers actually pay.

There is widespread anecdotal evidence that compliance is spotty thus far (and the maximum annual penalty for non-compliance would only amount to about $100,000, which is equal to about four hospital admissions), but CMS is currently conducting an audit of some hospitals to determine whether they’re in compliance with the new rule. Hospital compliance is expected to ramp up in the coming weeks, but a lot remains to be seen in terms of how much impact the transparency rules will actually have on consumer decision-making.

Legislation in Minnesota would expand MinnesotaCare, create a public option

HF11, sponsored by Rep. Jennifer Shultz (DFL, District 7A), was introduced in Minnesota last week, calling for various changes to the MinnesotaCare program that would allow more people to enroll. MinnesotaCare is a Basic Health Program, which provides coverage to people who aren’t eligible for Medicaid and who have household incomes of up to 200 percent of the poverty level.

HF11 would extend MinnesotaCare eligibility to undocumented immigrants, and would also eliminate the “family glitch” for MinnesotaCare eligibility. HF11 would also create a public option, via MinnesotaCare buy-in, for people with income above 200 percent of the poverty level, with a sliding fee scale for premiums. The legislation would also allow small employers to buy into the MinnesotaCare program as a means of providing coverage for their employees.

Rep. Shultz published an op-ed in the Minnesota Reformer last week, outlining her goals for health care reform and the incremental steps that Minnesota could take to make coverage and care more accessible and affordable in the state.

Utah Insurance Department proposes new minimum standards for short-term health plans

The Utah Insurance Department has proposed new minimum standards for short-term health insurance coverage, including a benefit cap of at least $1 million, copayments/coinsurance that can’t exceed 50 percent of covered charges, and various inpatient and outpatient services that would have to be covered. But the three benefit categories that are most commonly excluded on short-term plans – outpatient prescription drugs, mental health care, and maternity care – are not among the mandated benefits that the Department has proposed. The Department is accepting public comments on the proposal until March 3.

BCBS Association suspends contributions to members of Congress who voted to reject electoral college results

Last Friday, the Blue Cross Blue Shield Association announced that it was suspending political contributions “to lawmakers who voted to undermine our democracy,” referring to the members who challenged the electoral college results from the November presidential election. Numerous other companies have followed suit, including Disney and Wal-Mart, but the Blue Cross Blue Shield Association was the first major healthcare group to take this step. Others have since announced similar decisions, including PhRMA, and to a lesser degree, Cigna. The Blue Cross Blue Shield Association represents the 36 independent Blue Cross Blue Shield insurers that operate across the country, insuring more than 107 million Americans.


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 13, 2021 appeared first on healthinsurance.org.

https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png 512 512 wpmaddoxins https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.png wpmaddoxins2021-01-13 18:52:352021-01-14 14:27:22The Scoop: health insurance news – January 13, 2021

The Scoop: health insurance news – January 6, 2021

January 6, 2021/in covid-19, health reform, immigrant coverage, open enrollment, short term health insurance, special enrollment period /by wpmaddoxins

In this edition

  • Democrats win both Georgia Senate races, paving way for federal health policy reforms
  • Maryland opens a new COVID-related special enrollment period
  • Open enrollment ends in five states on January 15
  • Legislation introduced in New York to create a health insurance guaranty fund
  • North Dakota legislation calls for longer but more robust short-term health insurance plans
  • Haven shutting down three years after beginning a joint venture to improve healthcare quality and affordability
  • Appeals court panel allows Trump administration to deny visas to immigrants without health insurance, but Biden expected to reverse this rule
  • California prohibits insurers from denying gender-affirming medical care based on age
  • New prior authorization consumer protections in Minnesota

Democrats win both Georgia Senate races, paving way for federal health policy reforms

The biggest health policy news this week is the victory of both Rev. Raphael Warnock and Jon Ossoff in Georgia’s runoff Senate races. Their wins bring the Senate to a 50-50 split, with Vice President-elect Kamala Harris casting tie-breaking votes as necessary. There is a wide range of administrative health policy actions that the Biden administration will be able to implement without involving Congress, but the shift in power in the Senate opens the door for a variety of changes that require legislation but that can be accomplished with just 51 votes in the Senate – including making the California v. Texas lawsuit moot before the Supreme Court issues its ruling later this year.

Maryland opens new COVID-related special enrollment period

Maryland was one of just two state-run exchanges that opted to not extend open enrollment for 2021 coverage. But Maryland announced this week a new COVID-related special enrollment period for uninsured residents, which will continue through March 15. Maryland previously offered one of the nation’s longest COVID-related special enrollment periods, which began last March and continued through December 15, 2020. The new special enrollment period offers the same generous effective date rules that the state was using in 2020, allowing uninsured residents to sign up for coverage with an effective date that’s either retroactive or no more than two weeks after the date they enroll. Uninsured Maryland residents who enroll by January 15 will have coverage backdated to January 1.

Open enrollment ends in five states on January 15

Open enrollment for individual/family health plans is still ongoing in ten states and DC. But it ends next Friday, January 15, in five of those states:

  • Colorado
  • Connecticut
  • Pennsylvania
  • Nevada
  • Washington

Residents in those states can still enroll in a plan with a February 1 effective date. But after January 15, a qualifying event will be necessary in order to enroll.

Legislation introduced in New York to create a health insurance guaranty fund

Legislation has been introduced in New York that would create a health insurance guaranty fund that would step in to cover unpaid claims if a health insurance company becomes insolvent. Most states already have health insurance guaranty funds, but New York’s existing guaranty fund covers life insurance companies but not health insurance companies.

New York’s legislature considered similar legislation in 2016 after New York’s health insurance CO-OP failed (and again in each of the subsequent legislative sessions). But it was opposed by both Gov. Cuomo and the state’s health insurers, who objected to the assessment that would have been charged to fund the program. The current bill has 35 sponsors in New York’s Assembly, all of whom are Democrats.

North Dakota legislation calls for longer but more robust short-term health insurance plans

Legislation (SB2073) has been introduced in North Dakota, at the request of Insurance Commissioner Jon Godfread, that would allow for short-term health insurance plans with longer durations but also stronger consumer protections. Under North Dakota’s current rules, short-term health insurance plans can have terms of no more than 185 days. One renewal is permitted, but the total duration of these plans cannot exceed one year, including the renewal period.

The newly introduced legislation calls for the state to allow association short-term limited duration health plans to follow current federal rules, which means they could have total durations of up to 36 months. But while federal rules allow short-term plans to be renewable (for up to 36 months in total), North Dakota’s SB2073 would require association short-term plans to be renewable at the option of the insured.

SB2073 would also require association short-term health plans to cover all of the ACA’s essential health benefits, with the exception of pediatric dental and vision services. This would be a significant change, as short-term health plans are not currently required to cover essential health benefits, and most tend to lack coverage in at least a few of the essential health benefit categories.

Haven closing three years after beginning joint venture to improve healthcare quality and affordability

Three years ago, Amazon, Berkshire Hathaway, and JPMorgan Chase & Co. announced a new partnership to “address healthcare for their U.S. employees, with the aim of improving employee satisfaction and reducing costs.” Their new joint venture, named Haven, was an independent entity, “free from profit-making incentives and constraints,” which set out to shake up the conventional health insurance model and provide “simplified, high-quality and transparent healthcare at a reasonable cost.”

But as David Anderson noted at the time, this was never going to be an easy road. And Haven announced this week that it will no longer exist as an independent entity as of the end of February. Amazon, Berkshire Hathaway, and JPMorgan Chase & Co. plan to “continue to collaborate informally” as they work on health care solutions for their own employees, but they’re winding down their joint venture.

Appeals court panel allows Trump administration to deny visas to immigrants without health insurance, but Biden expected to reverse this rule

More than a year ago, the Trump administration issued a proclamation that requires immigrants to have health insurance – or proof that they would have coverage within 30 days of entering the country – in order to obtain a visa. The rule was blocked by a judge before it could take effect, but a three-judge panel for the U.S. Court of Appeals for the Ninth Circuit overturned that injunction last week in a 2-1 ruling.  The court’s ruling does not take effect immediately, however, and the Biden administration is expected to overturn the rule soon after taking office, making it unlikely that the health insurance requirements for immigrants will be implemented.

California prohibits insurers from denying gender-affirming medical care based on age

Last week, the California Department of Insurance notified health insurers in the state that they cannot deny coverage solely based on age when an insured is undergoing a gender-affirming female-to-male transition and seeking male chest reconstruction surgery. The Department was made aware of several insurers that had denied these claims solely due to the patient being under the age of 18, and took action to address the issue. The state’s letter to insurers clarifies that mastectomy and male chest reconstruction can be carried out while the person is still a minor, and that any claims decisions should be made on a case-by-case basis and cannot discriminate based on age.

New prior authorization consumer protections in Minnesota

A new law took effect on January 1 in Minnesota, expanding consumer protections with regards to prior authorization in health insurance. When a consumer switches from one health plan to another, the state now requires the person’s new insurer to honor, for at least the first 60 days, any prior authorizations that had been granted by the prior insurer. The new law also prohibits insurers from revoking already-approved prior authorizations unless the authorization was based on fraud or misinformation or was in conflict with state or federal law. And insurers are required to publicize a wide range of data pertaining to prior authorizations, making it easier for consumers to see how frequently these requests are approved or denied, and the reasons that prior authorization requests are rejected.


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 6, 2021 appeared first on healthinsurance.org.

https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png 512 512 wpmaddoxins https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.png wpmaddoxins2021-01-06 14:41:532021-01-06 18:22:29The Scoop: health insurance news – January 6, 2021

Miss open enrollment? You’ve got options.

January 4, 2021/in health plan enrollment, Obamacare, open enrollment, short term health insurance /by wpmaddoxins

Key takeaways

  • Native Americans and people eligible for Medicaid/CHIP can enroll year-round.
  • If you’ve got a qualifying event, you can enroll in coverage.
  • If none of those apply, a short-term plan is the closest thing to real insurance in most states.
  • Federal regulations allow a short-term plan (with renewals) to last up to 36 months, although about half the states have more restrictive rules.

In the individual/family health insurance market (ie, coverage that people buy for themselves, as opposed to getting from an employer), open enrollment for 2021 coverage ended on December 15 in most states. But there are some states with extended enrollment deadlines, several of which are ongoing as of January 2021. And Maryland has opened a COVID-related special enrollment period for uninsured residents, which continues through March 15, 2021.

Millions of Americans purchased ACA-compliant plans through the exchanges — and outside the exchanges — during open enrollment. But there are still millions of Americans who don’t have coverage as of early 2021 (the uninsured rate has been increasing since 2017, due to the Trump administration’s approach to health care reform).

If you didn’t sign up for health insurance during open enrollment, you may have to wait until November 2021 to sign up for a plan that will take effect in 2022. But you may find that you can still get coverage for 2021, even if open enrollment has ended in your state. Let’s take a look.

Native Americans, those eligible for Medicaid/CHIP can enroll year-round

Native Americans can enroll in exchange plans year-round.

And people who qualify for Medicaid or CHIP can also enroll at any time. Income limits are fairly high for CHIP eligibility, so be sure you check your state’s eligibility limits before assuming that your kids wouldn’t be eligible – benefits very much extend to middle-class households.

And in states where Medicaid has been expanded, a single individual earning up to $17,608 can enroll in Medicaid. (This amount will be higher after the FPL numbers for 2021 become available). Most states have expanded Medicaid, and Oklahoma and Missouri will join them in mid-2021. But there are still 14 states (dropping to 12 once Medicaid expansion takes effect in Oklahoma and Missouri) where there is a Medicaid coverage gap and assistance is not available for most adults with income below the poverty level.

Similarly, if you’re on Medicaid and your income increases to a level that makes you ineligible for Medicaid, you’ll have an opportunity to switch to a private plan at that point, with the loss of your Medicaid plan serving as the qualifying event that triggers a special enrollment period.

A qualifying event at any time of the year will likely to allow you to enroll

Applicants who experience a qualifying event gain access to a special enrollment period (SEP) to shop for plans in the exchange (or off-exchange, in most cases) with premium subsidies available in the exchange for eligible enrollees.

HHS stepped up enforcement of special enrollment period eligibility verification in 2016, and further increased the eligibility verification process in 2017. So if you experience a qualifying event, be prepared to provide proof of it when you enroll.

And in most cases, the current rules limit SEP plan changes to plans at the same metal level the person already has. The state-run exchanges (ie, the ones that don’t use HealthCare.gov) can use their own discretion on this, but in general, if you’re enrolling mid-year, be prepared to provide proof of the qualifying event that triggered your special enrollment period, and know that you might not be able to switch to a more robust or less robust plan (eg, from bronze to gold or vice versa) during your SEP. And understand that in most — but not all — cases, the current SEP rules allow you to change your coverage but not necessarily go from being uninsured to insured. So you may be asked to provide proof of your prior coverage in addition to proof of the qualifying event.

For example, although a permanent move to an area where different health plans are available used to trigger a SEP regardless of whether you had coverage before the move, that’s no longer the case. You must have coverage in force before your move in order to qualify for a SEP in your new location. The same is true of getting married: In most cases, at least one spouse must have already had coverage in order for the marriage to trigger a SEP.

And without a qualifying event, major medical health insurance is not available outside of general open enrollment, on or off-exchange. This is very different from the pre-2014 individual health insurance market, where people could apply for coverage at any time. But of course, approval used to be contingent on health status, which is no longer the case.

If you’re curious about your eligibility for a special enrollment period, call (800) 436-1566 to discuss your situation with a licensed insurance professional.

The closest thing to ‘real’ insurance if you missed open enrollment

For people who didn’t enroll in coverage during open enrollment, aren’t eligible for employer-sponsored coverage or Medicaid/CHIP, and aren’t expecting a qualifying event later in the year, the options for 2021 coverage are limited to policies that are not regulated by the ACA and are thus not considered minimum essential coverage.

And most of these plans are designed to be supplemental coverage, rather than a person’s only health coverage. This includes things like limited-benefit plans, accident supplements, critical/specific-illness policies, dental/vision plans, and medical discount plans.

But there are a few types of coverage that are available year-round (generally only to fairly healthy individuals), and that can serve as stand-alone coverage in a pinch:

Farm Bureau plans in a few states

In Kansas, Tennessee, Indiana, and Iowa, members of Farm Bureau who are healthy enough to get through medical underwriting can enroll in Farm Bureau plans that are technically not considered insurance — and thus don’t have to comply with insurance regulations — but that are available for purchase year-round.

Farm Bureau plans are also available in Nebraska, without medical underwriting, for people who are actively engaged in agriculture, but these plans use the same November 1 – December 15 open enrollment period that applies to ACA-compliant plans in Nebraska.

Health care sharing ministry plans

There are also health care sharing ministry plans available nearly everywhere, and although they are not compliant with insurance laws, they are better than nothing and are available year-round to people who meet their eligibility criteria.

Short-term health plans

Short-term health insurance is available in all but eleven states, and can serve as decent coverage if your other alternative is to remain uninsured. In most states, it’s the closest thing you can get to “real” health insurance if you find yourself needing to purchase a policy outside of open enrollment without a qualifying event.

For most of 2017 and 2018, short-term plans were capped at three months in duration, due to an Obama administration regulation. But HHS finalized new rules that drastically expanded the allowable duration of short-term plans as of October 2018.


The Obama-Administration HHS implemented the regulation to cap short-term plans at three months in an effort aimed at “curbing abuse” of short-term plans. At that point, under HHS Secretary Sylvia Matthews-Burwell, HHS noted that short-term plans are exempt from having to comply with ACA regulations specifically because they’re supposed to only be used to fill gaps in coverage — but instead, people had been using them for up to a year at a time, effectively removing healthy people from the ACA-compliant risk pool and destabilizing it over the long-run.

In 2017, several GOP Senators asked HHS to reverse this regulation and go back to allowing short-term plans to be issued for durations up to 364 days. And the Trump administration confirmed their commitment to rolling back the limitations on short-term plans in an October 2017 executive order. The new rules took effect in October 2018, implementing the following provisions:

  • Short-term plans can now have initial terms of up to 364 days.
  • Renewal of a short-term plan is allowed as long as the total duration of a single plan doesn’t exceed 36 months (people can string together multiple plans, from the same insurer or different insurers, and thus have short-term coverage for longer than 36 months, as long as they’re in a state that permits this).
  • Short-term plan information must include a disclosure to help consumers understand the potential pitfalls of short-term plans and how they differ from individual health insurance.

But states can still impose stricter rules, and over half the states do so. Some are long-standing rules, while others are newly-adopted rules that states have implemented in an effort to prevent the Trump administration rules from destabilizing their individual insurance markets and pushing healthy people into less comprehensive coverage.

Although premium subsidies (a type of tax credit) are not available for short-term plans, the retail prices on these policies are more affordable than the retail price (ie, unsubsidized) on ACA-compliant plans, and they do still serve as a good stop-gap if you just need the policy to cover you for a few months when you’re in between other policies. However, if your income makes you eligible for the Obamacare premium subsidies, it’s essential that you enroll through your state’s exchange during open enrollment (or a special enrollment period triggered by a qualifying event like losing access to your employer-sponsored health insurance); otherwise, you’re missing out on comprehensive health insurance and a tax credit.

Some short-term plans have provider networks, but others allow you to use any provider you choose (keep in mind, however, that you’ll likely be subject to balance billing if your plan doesn’t have a provider network, since the providers will not be bound by any contract with your insurer regarding the pricing for their services).

And short-term policies are not required to be renewable; the new federal rule allows insurers to offer renewable short-term plans, but does not require them to do so. Depending on your state’s regulations and your insurer’s business plan, you may be able to renew your short-term plans, or you may be able to purchase a new short-term policy when your existing one expires. But if you’re buying a new policy, the purchase will require new underwriting, and in most cases, the new policy will not cover pre-existing conditions, including any that began while you were covered under the first short-term policy.

Unlike ACA-compliant plans, short-term policies have benefit maximums. But the limits on some short-term plans tend to be more reasonable than the infamous pre-ACA “mini-med” plans that barely covered a few nights in the hospital. Lifetime maximums of $750,000 to $2 million are common on short-term plans. While this is not as good as regular individual insurance plans that no longer have annual or lifetime benefit caps, it’s roughly similar to a lot of the plans that were available several years ago in the individual market. And the concept of a “lifetime” limit doesn’t really matter when you’re talking about a plan that lasts for at most 36 months (the maximum amount of time a single plan can remain in effect under the new federal rules), since you won’t be able to purchase another short-term plan if you develop a serious health condition.

But you’ll see plenty of short-term policies with much lower benefit limits. As a general rule, you’ll want to focus on plans that offer at least $1 million in benefits — health care is shockingly expensive.

Short-term insurance applications

The application process is very simple for short-term policies. Once you select a plan, the online application is much shorter than it is for standard individual health insurance, and coverage can be effective as early as the next day.

There are no income-related questions (since short-term policies are not eligible for any of the ACA’s premium subsidies), and the medical history section is generally quite short – nowhere near as onerous as the pre-2014 individual health insurance applications were.

Keep in mind that although the medical history section generally only addresses the most serious conditions in order to determine whether or not the applicant is eligible for coverage, short-term plans generally have blanket disclaimers stating that no pre-existing conditions are covered.

And post-claims underwriting is common on short-term plans. So although the insurer may accept your application based simply on what you disclose when you apply, they can — and likely will — go back through your medical history with a fine-toothed comb if and when you have a significant claim. If they find anything indicating that the current claim might be related to a pre-existing condition, they can rescind your coverage or deny the claim. So although a short-term plan might work well to cover a broken leg, it’s going to be less useful if you end up with a health condition that tends to take a while to develop, as the insurer may determine that the condition, or something related to it, began before your coverage was in force. This story is a good example of how this works.

Clearly, short-term plans are not as good as the ACA-regulated policies that you can purchase during open enrollment or during a special enrollment period. Short-term insurance is not regulated by the ACA, so it doesn’t have to follow the ACA’s rules: The plans still have benefit maximums, and they are not required to cover the ten essential benefits. (Most often, short-term plans don’t cover maternity, prescription drugs, preventive care, or mental health/addiction treatment), they do not have to limit out-of-pocket maximums, and they do not cover pre-existing conditions. They also still use medical underwriting, so coverage is not guaranteed issue.

The majority of short-term plans do not cover outpatient prescriptions. Using a pharmacy discount card may lower medication costs without health insurance, and some discount prices may be lower than an insurance copay.

Not a qualifying event: losing short-term coverage

Although loss of existing minimum essential coverage is a qualifying event that triggers a special open enrollment period for ACA-compliant individual market plans, short-term policies are not considered minimum essential coverage, so the loss of short-term coverage is not a qualifying event (loss of a short-term plan is a qualifying event for employer-sponsored coverage, however, so you’d be able to enroll in your employer’s plan when you short-term plan ends).

Let’s say you lose your job and your employer-sponsored health plan. You then have a 60-day window during which you can enroll in an ACA-compliant plan.

You also have the option to buy a short-term plan at that point, and it may be available with a term of up to a year, depending on where you live. But when the short-term plan ends, you would no longer have access to an ACA-compliant plan (you’d have to wait until the next open enrollment, and a plan selected during open enrollment would become effective on January 1) and although you could purchase another short-term plan, your eligibility would depend on your current medical history. [Some short-term plan insurers offer guaranteed renewability under the new federal rules, meaning that people can renew the plan, without going through medical underwriting, and keep it for up to 36 months. But not all insurers offer this option.]

Although short-term plans do not provide the level of coverage or consumer protections that the new ACA-compliant plans offer, obtaining a short-term policy is better than remaining uninsured. But your best bet is to maintain coverage under an ACA-compliant policy; if you’re not enrolled, you’ll want to do so if you experience a qualifying event (most people don’t take advantage of their qualifying events, perhaps unaware that their opportunity to enroll is limited).


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 Miss open enrollment? You’ve got options. appeared first on healthinsurance.org.

https://www.maddoxinsured.com/wp-content/uploads/2021/01/short-term-health-insurance-state-map.jpg 630 1200 wpmaddoxins https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.png wpmaddoxins2021-01-04 01:01:572021-01-06 18:22:34Miss open enrollment? You’ve got options.

What are the deadlines for Obamacare’s open enrollment period?

January 4, 2021/in enrollment, enrollment deadline, open enrollment /by wpmaddoxins

Key takeaways

  • Open enrollment for 2021 coverage ended on December 15, 2020 in most states.
  • California, Colorado, and Washington, DC, have permanently extended open enrollment.
  • Ten other state-run exchanges (for a total of 13) extended the open enrollment period for 2021 health plans; 11 of those are still ongoing as of early January, and Maryland has opened a COVID-related special enrollment period for uninsured residents.
  • State-run exchanges have flexibility to make OEP longer.
  • Outside of open enrollment, you’ll need a qualifying event to enroll.

Q. What is the deadline to enroll in health insurance coverage in the individual market?

open enrollment 2021

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

A.  In most states, open enrollment for 2021 health plans ended on December 15, 2020. HealthCare.gov, which is the exchange platform that’s used by the majority of the states, tends to follow this schedule fairly closely, while the states that run their own exchange platforms generally offer slightly longer enrollment windows.

HealthCare.gov is being used in 36 states for enrollment in 2021 health plans (it was 38 states as of 2020, but Pennsylvania and New Jersey have both transitioned to their own enrollment platforms as of the fall of 2020; both have also opted to extend their open enrollment windows).

As described below, California, Colorado, and DC have opted to permanently extend their open enrollment periods. And most of the other fully state-run exchanges have opted to extend the open enrollment period for 2021 coverage, meaning it will continue past December 15.

Outside of open enrollment, plan changes and new enrollments are only possible for people who experience a qualifying event.

Native Americans and Alaska Natives can enroll year-round in plans offered in the exchange. Applicants who are eligible for Medicaid or CHIP can also enroll year-round.

States where open enrollment ended on December 15, 2020

In the following states, open enrollment ended on December 15 (although due to high call volume on December 15, HealthCare.gov had some callers leave their contact information; the exchange will call these people back over the next few days to complete their enrollment in 2021 coverage):

  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • Delaware
  • Florida
  • Georgia
  • Hawaii
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland (but Maryland has opened a COVID-related special enrollment period through March 15, 2021)
  • Michigan
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • New Hampshire
  • New Mexico
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont (state had the option to extend enrollment but chose not to do so)
  • Virginia
  • West Virginia
  • Wisconsin
  • Wyoming

California, Colorado, and DC: Open enrollment has been permanently extended

California: November 1 – January 31. California enacted legislation in 2017 and again in 2019 that permanently establishes different enrollment dates within the state, both on and off-exchange. Open enrollment for 2021 health plans began November 1, 2020 and will continue through January 31, 2020. California’s enrollment schedule has varied in previous years, but this three-month window, from the beginning of November through the end of January, will be the permanent enrollment window going forward.

Colorado: November 1 – January 15. Colorado’s Division of Insurance has also permanently extended open enrollment. The state finalized regulations in late 2018 that call for an annual special enrollment period, running from December 16 to January 15, that is added to the end of open enrollment each year. So open enrollment in Colorado will effectively last 2.5 months for all future enrollment periods (November 1 to January 15). Plans selected between December 16 and January 15 must take effect no later than February 1 (for 2021 coverage, the exchange is giving people until December 18 to enroll, although they have to call the customer service center to request a January 1 effective date if they’re enrolling between December 16 and 18).

DC: November 1 – January 31. DC’s exchange board voted unanimously to permanently implement an open enrollment window that runs from November 1 to January 31.

Compare plans and rates in your ZIP code



Enrollment for 2021 health plans still open in ten states and DC

In addition to the three permanent extensions described above, open enrollment for 2021 health plans has also been extended in ten of the other 12 fully state-run exchanges. The extended deadline has already passed in Minnesota and Idaho, but open enrollment is still ongoing as of early January in ten states and DC, with the following enrollment deadlines:

  • Colorado: January 15
  • Connecticut January 15
  • Pennsylvania: January 15
  • Nevada: January 15
  • Washington: January 15
  • Massachusetts: January 23
  • Rhode Island: January 23
  • California: January 31
  • DC: January 31
  • New Jersey: January 31
  • New York: January 31

The deadline for a January 1 effective date has passed in all of those states, so enrollments are currently (as of early January) being processed for a February 1 effective date.

Although open enrollment ended on December 15 in Maryland, the state announced in early January that it was opening a new COVID-related special enrollment period that will continue through March 15, 2021. Uninsured Maryland residents can use this window as an opportunity to enroll in coverage through Maryland’s exchange, but people who already have coverage cannot make plan changes during this window.

Minnesota‘s exchange and Idaho‘s exchange also extended open enrollment, but they ended December 22 and December 31, respectively. Idaho announced its extension on December 18 (three days after the original deadline had passed; this is the first time Idaho’s exchange has ever added a significant extension to open enrollment). Connecticut stuck with a December 15 deadline right up until the end of open enrollment, and then announced an additional month starting on December 16.

The only other fully state-run exchanges are in Vermont and Maryland, so they’re the only other states that had the option to extend open enrollment beyond the deadline that HealthCare.gov imposes. But both of them opted to end open enrollment on December 15. As noted above, however, Maryland is allowing uninsured residents a COVID-related special enrollment period that continues through March 15, 2021.

State-run exchanges have some flexibility on open enrollment schedule

The 2017 market stabilization rule noted that the November 1-December 15 open enrollment period would apply in every state in the fall of 2017. However, they also noted that some state-based exchanges — there are 13 of them as of 2020, and potentially 16 as of 2021 — might experience logistical difficulties in getting their systems ready for the new schedule on a fairly tight timeframe.

As such, the market stabilization rule clarified that state-based exchanges could use their own flexibility to “supplement the open enrollment period with a special enrollment period, as a transitional measure, to account for those operational difficulties.” Since then, the majority of the state-based exchanges have opted to extend open enrollment for most years.

For 2020 enrollments, Maryland, Vermont, and Nevada opted to keep the December 15 end date (and Idaho came very close to it; their reason for a one-day extension was that their call center isn’t open on Sundays, and the 15th fell on a Sunday. In general, Idaho residents should expect that the enrollment window will not be extended in the future, given how well they’ve adhered to that deadline for the last few years).

As we can see from the decisions in DC, California, and Colorado (to permanently extend open enrollment), and in Pennsylvania and Nevada (to extend open enrollment for 2021 coverage), states with their own enrollment platforms still have flexibility going forward. HHS has defined open enrollment as the window from November 1 to December 15, and that applies in every state. But state-run exchanges have the option to offer special enrollment periods before or after that window, in order to effectively extend open enrollment.

In addition to Pennsylvania, New Jersey is expected to also have state-run exchange platform by the fall of 2020; New Mexico plans to join them in the fall of 2021, and Maine might do so as well by the fall of 2021. Oregon may join them in the future as well. Fully state-run exchanges are the only ones with the ability to extend open enrollment on their own (in the other states, the decision has to come from CMS, since the extension has to be issued via HealthCare.gov), and most of them have been choosing to do so each year.

Outside of the open enrollment window, enrollment is only available with a qualifying event

After open enrollment ends, people can only purchase coverage if they have a special enrollment period triggered by a qualifying event such as:

  • Marriage (since 2017, this generally only applies if at least one spouse already had coverage before the wedding, although there are some exceptions),
  • Becoming a U.S. citizen,
  • Birth or adoption,
  • Involuntary loss of other health coverage.
  • A permanent move to an area where new health plans are available (since July 2016, this only applies in most cases if you already had coverage prior to your move).
  • Here’s a complete guide to qualifying events in the individual market, and their associated special enrollment periods.

Regardless of whether you purchase insurance through the exchange or off-exchange, the annual open enrollment window applies, and special enrollment periods are necessary in order to enroll at any other time of the year.

In 2016, HHS tightened up the rules regarding eligibility for special enrollment periods, and they further tightened the rules in 2017, as part of the market stabilization rule. As a result, the rules are being followed much more closely than they were in previous years, and in most states, anyone enrolling during a special enrollment period is required to provide proof of the qualifying event that they experienced.


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 What are the deadlines for Obamacare’s open enrollment period? appeared first on healthinsurance.org.

https://www.maddoxinsured.com/wp-content/uploads/2021/01/open-enrollment-2021-400x203-1.jpg 203 400 wpmaddoxins https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.png wpmaddoxins2021-01-04 01:01:312021-01-06 19:56:26What are the deadlines for Obamacare’s open enrollment period?

The Scoop: health insurance news – December 30, 2020

December 30, 2020/in balance billing, health reform, Medicaid eligibility, open enrollment /by wpmaddoxins

In this edition

  • Open enrollment continues in 11 states and DC, ends Thursday in Idaho
  • Federal protections against surprise balance billing will take effect in January 2022
  • Today is final day to submit a comment on proposed health insurance rule changes for 2022
  • Effectuated enrollment for the first half of 2020 was about 3.4% higher than 2019
  • State insurance commissioners send policy recommendations to President-elect Biden
  • California law will help people transition seamlessly to exchange if they lose coverage
  • Medicaid eligibility restored for COFA citizens

Open enrollment continues in 11 states and DC, ends Thursday in Idaho

Although open enrollment for 2021 health plans ended in mid-December in most states, it’s still ongoing in Washington, DC, and 11 states. Idaho’s open enrollment period is the next to end, on December 31; the others will continue to allow people to enroll until mid or late January.

special enrollment period for marriage

Miss open enrollment? You may be eligible for a special enrollment period if you have a qualifying life event.

In Idaho, Nevada, Rhode Island, California, New Jersey, and New York, you can still enroll now for coverage that takes effect on Friday, January 1. (The deadline for this is today in California, and tomorrow in the rest of those states.)

In Colorado, Connecticut, Pennsylvania, Washington, Massachusetts, and Washington, DC, new enrollments are currently being processed for a February 1 effective date.

If you’re in a state where open enrollment is ongoing and you’ve got questions, check out our comprehensive guide to open enrollment. If you live elsewhere, you may still be able to enroll if you experience a qualifying event that triggers a special enrollment period.


Federal protections against surprise balance billing will take effect in 2022

President Trump signed the Consolidated Appropriations Act, 2021, into law on Sunday, following a brief delay during which it was uncertain whether the bill would survive. The wide-ranging legislation includes fairly strong federal protections against surprise balance billing, which will take effect in January 2022.

Some states have tackled this issue on their own. Most recently, Ohio  state lawmakers passed HB388 last week, though the bill has not yet been signed into law. But state laws don’t apply to self-insured plans (which account for the majority of employer-sponsored coverage) and many states have not yet enacted consumer protections against surprise balance billing.

There has long been a need for federal action on this issue, and broad bipartisan consensus that consumers should not be stuck in the middle of surprise balance billing situations. But ironing out the details between medical providers and insurers has taken years of debate. The new law will mostly ensure that consumers are not responsible for additional charges when they see out-of-network providers at an in-network facility or during an emergency situation. But notably, the law will still allow for surprise balance billing from ground ambulance services.

Today is final day to submit a comment on proposed health insurance rule changes for 2022

The day before Thanksgiving, CMS published the proposed Notice of Benefit and Payment Parameters for 2022. This annual rulemaking document is lengthy and covers a wide range of provisions, but we summarized several that might have the most direct impact on consumers.

CMS is accepting public comments on the proposed rules, but only through midnight tonight. If you want to comment, you can do so by going to the proposed rule and clicking on the “submit a formal comment” tab on the right side of the page. You can see the comments that other people have submitted – including this detailed and thoughtful comment from Charles Gaba – which might help you clarify your own concerns or suggestions for CMS.

Effectuated enrollment for the first half of 2020 was about 3.4% higher than 2019

CMS has published effectuated marketplace enrollment data for the first half of 2020. Not surprisingly, average effectuated enrollment from January to June this year was higher than last year, by about 350,000 people. For the first six months of 2020, an average of more than 10.5 million people had effectuated coverage through the marketplaces, versus under 10.2 million during the same time period in 2019. As explained here by Andrew Sprung, effectuated enrollment for just the month of June was likely even more significantly elevated when compared with June of 2019, although those official numbers aren’t yet available.

Average monthly premiums were about 3 percent lower than they had been in 2019, and average monthly premium subsidy (premium tax credit) amounts were about 4 percent lower. This is not surprising, given that average premiums for existing plans decreased slightly in 2020 and insurers entered the marketplaces in at least 19 states, in some cases with premiums that were lower than the existing plans’ rates. (In states that use HealthCare.gov, average benchmark plan premiums were 4 percent lower in 2020 than they had been in 2019, and premium subsidy amounts are based on the cost of the benchmark plan in each area.)

State insurance commissioners send policy recommendations to President-elect Biden

Last week, insurance commissioners from Colorado, Pennsylvania, Rhode Island, Oregon, California, Delaware, Hawaii, Washington, Minnesota, Michigan, and Wisconsin sent a letter to President-elect Biden, making health policy recommendations that the incoming administration could implement in order to improve access to health coverage and medical care.

The recommendations are summarized here, and include immediately available actions, such as opening up a special enrollment period on HealthCare.gov in conjunction with restored federal funding for outreach, mitigating the unexpected tax hits that people may unexpectedly face next spring when they reconcile their 2020 premium tax credits, and issuing an interim final rule to reverse some of the proposed rule changes for 2022, if the Notice of Benefit and Payment Parameters are finalized (without significant changes) prior to Biden’s inauguration.

The letter also implores the Biden administration to make various long-term changes, including the reversal of rules that were put in place under the Trump administration that led to increasing uninsured rates and the proliferation of non-comprehensive health plans.

California law will help people transition seamlessly to exchange if they lose coverage

California Senate Bill 260, which was signed into law in 2019 and takes effect on Friday, will help to ensure that California residents who lose their health insurance are able to easily transition to coverage through Covered California (the state-run exchange), which can be either a private plan or Medi-Cal, depending on the person’s financial situation.

Under the terms of the new law, state-regulated health plans in California will provide the exchange with contact information of any plan member whose coverage terminates, unless the person has specifically opted out of this program. The exchange will then be able to reach out to these individuals to let them know what coverage options and financial assistance are available to them.

Starting in July, SB260 will also require Covered California to automatically enroll people who are losing Medi-Cal coverage into the lowest-cost available Silver plan, although the person will also be given the option to select a different plan or to reject the auto-enrollment altogether.

Medicaid eligibility restored for COFA citizens

In addition to COVID-19 relief, surprise balance billing protections, and a host of other reforms, the Consolidated Appropriations Act, 2021 also restores access to Medicaid for citizens from the Marshall Islands, Palau, and the Federated States of Micronesia who live in the United States under the terms of the Compacts of Free Association.

A drafting error in the 1996 welfare reform legislation eliminated Medicaid access for COFA migrants, and it’s taken nearly a quarter of a century of advocacy and legislative efforts to restore it. As many as 94,000 COFA migrants nationwide could benefit from the restored access to Medicaid, which took effect immediately when the law was enacted.


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 – December 30, 2020 appeared first on healthinsurance.org.

https://www.maddoxinsured.com/wp-content/uploads/2020/12/special-enrollment-period-marriage-400x203-1.jpg 203 400 wpmaddoxins https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.png wpmaddoxins2020-12-30 14:47:342021-01-06 18:22:35The Scoop: health insurance news – December 30, 2020

The Scoop: health insurance news – December 23, 2020

December 23, 2020/in balance billing, grandfathered health plans, health reform, open enrollment, The Scoop /by wpmaddoxins

In this edition

  • Open enrollment continues in 11 states, Washington, DC
  • Enrollment up 6.6% for 2021 in states that use HealthCare.gov
  • Trump administration finalizes rule changes for grandfathered group plans
  • Congress passes legislation to protect consumers from surprise balance billing
  • Congress passes legislation to make health insurers subject to federal antitrust laws
  • Ohio enacts legislation to end “fail first” drug requirements for stage 4 cancer treatment
  • Delaware proposal calls for increased investment in primary care

Open enrollment continues in 11 states, Washington, DC

Although open enrollment for 2021 individual and family health insurance ended last week in most states, and ended last night in Minnesota, open enrollment is still ongoing in 11 states and Washington, DC, with the following enrollment deadlines:

  • Idaho: December 31 (enroll by December 31 for a January 1 effective date)
  • Colorado: January 15
  • Connecticut January 15
  • Pennsylvania: January 15
  • Nevada: January 15 (enroll by December 31 for a January 1 effective date)
  • Washington: January 15
  • Massachusetts: January 23 (enroll by December 23 for a January 1 effective date)
  • Rhode Island: January 23 (enroll by December 31 for a January 1 effective date)
  • California: January 31 (enroll by December 30 for a January 1 effective date)
  • DC: January 31
  • New Jersey: January 31 (enroll by December 31 for a January 1 effective date)
  • New York: January 31 (enroll by December 31 for a January 1 effective date)

Enrollment up 6.6% for 2021 in states that use HealthCare.gov

Last Friday, CMS published preliminary enrollment data for the 36 states that used HealthCare.gov during the open enrollment period that ended last week. Across those 36 states, a total of 8.23 million people enrolled in private plans through HealthCare.gov. As Charles Gaba notes, that’s a 6.6 percent increase over last year, after we account for the fact that Pennsylvania and New Jersey are now running their own exchange platforms and will report their enrollment numbers separately. (Both also have ongoing enrollment periods, as noted above.)

As detailed by Andrew Sprung, private-plan enrollment via the exchange in states that have not expanded Medicaid is about 10 percent higher for 2021 than it was for 2020, while enrollment is slightly lower in states that have expanded Medicaid. Sprung offers several explanations for this, including the fact that many who lost their incomes in 2020 have transitioned to Medicaid, which is more likely to be an available option in states that have expanded Medicaid. Sprung has also tracked the significant increase in the number of people covered by Medicaid this year.

Trump administration finalizes rule changes for grandfathered group plans

Earlier this month, the Trump administration finalized new rules for grandfathered group health plans. The rule change is essentially the same as the changes that the administration proposed in July, but the effective date has been pushed out to mid-June 2021, as opposed to the originally proposed effective date of 30 days after the rules were finalized.

Under the new rules, grandfathered group plans that are HSA-qualified will be able to make cost-sharing increases necessary to retain their HSA-qualified status, even if the increases exceed the limits that would otherwise have applied to grandfathered plans. (This situation has not yet arisen, but if it does in the future, the rule change will allow these plans to keep both their HSA-qualified status and their grandfathered status.) And the new rules will also allow grandfathered group plans to increase their cost-sharing amounts by a larger threshold than previously permitted, with allowable cost-sharing expected to be about 3 percentage points higher under the new rule.

Congress passes legislation to protect consumers from surprise balance billing

The surprise balance billing legislation that we told you about last week was included in the Consolidated Appropriations Act, 2021, which passed earlier this week with strong bipartisan support in both the House and Senate. President Trump was widely expected to sign it as soon as it reached his desk, but he cast doubt on that via Twitter on Tuesday night, expressing displeasure at some aspects of the legislation. Trump didn’t say that he would veto the bill, but the video he shared on Twitter indicated that the current bill is no longer a sure thing.

In its current form, the massive bill includes government funding for the first three quarters of 2021, extensive COVID-19 relief, and numerous other provisions, including strong consumer protections against surprise balance billing that will take effect in January 2022. As the Kaiser Family Foundation’s Larry Levitt explains in this Twitter thread, the new legislation provides strong consumer protections, and – assuming it does get signed into law – will result in consumers having to pay just their normal in-network cost-sharing when they receive emergency care or unknowingly receive care from an out-of-network provider at an in-network facility.

Protections against surprise balance billing for ground ambulance charges are not included in the legislation, despite the fact that ambulance rides often result in surprise balance billing. But the legislation does call for a commission that will study ground ambulance charges in hopes of incorporating additional consumer protections in a future piece of legislation.

Congresses passes legislation to make health insurers subject to federal antitrust laws

The Competitive Health Insurance Reform Act of 2020 – H.R.1418 – passed in the Senate last night and is now headed to President Trump’s desk (it was passed by the House in September). Under the terms of this legislation, health insurance companies will be subject to federal antitrust laws, reversing a 75-year-old exemption that was granted in 1945 via the McCarran-Ferguson Act.

Sens. Steve Daines (R-Montana) and Patrick Leahy (D-Vermont) shepherded the bipartisan bill through the Senate. In announcing the passage of the bill, Daines noted that it “will ensure that health insurance issuers are subject to the same federal antitrust laws prohibiting unfair trade practices, such as price-fixing and collusion, as virtually every other industry in our economy.” The rest of the McCarran-Ferguson Act – which gives states the right to regulate their insurance markets — is unchanged by H.R.1418.

Ohio enacts legislation to end ‘fail first’ drug requirements for stage 4 cancer treatment

This week, Ohio Gov. Mike DeWine signed a new law prohibiting Ohio health insurance plans from imposing “fail first” requirements on drug coverage for people with stage 4 cancer. S.B.252 prohibits insurers from requiring these patients to try a cheaper medication first and then only cover another medication if the first did not work. These “fail first” requirements are often imposed on newer, cutting-edge therapies that tend to be more expensive than older medications, but Ohio’s legislation stems from the fact that time is of the essence with metastatic cancer.

Delaware proposal calls for increased investment in primary care

Delaware’s Insurance Commissioner, Trinidad Navarro, and the state’s Office of Value-Based Health Care Delivery have published a report that outlines proposals for improving access to primary care in the state without increasing healthcare costs. The report calls for health insurers in Delaware to increase their investments in primary care while decreasing price growth for some other services, including hospital care, and to transition to a value-based payment model instead of a fee-for-service model. The state is accepting public comments on the report until January 25, 2021.


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 – December 23, 2020 appeared first on healthinsurance.org.

https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png 512 512 wpmaddoxins https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.png wpmaddoxins2020-12-23 06:58:022021-01-22 14:19:43The Scoop: health insurance news – December 23, 2020
Page 1 of 212

Resources

  • US Small Business Administration
  • Shelby County TN Business Tax Division

Latest News

  • American Modern Launches Digital Social Media Toolkit for AgentsApril 15, 2021 - 12:46 PM
  • McDonald’s to Require Employee Training to Combat Harassment, DiscriminationApril 15, 2021 - 7:30 AM
  • Hallmark Financial Plans to Pursue IPO of Specialty Commercial BusinessApril 15, 2021 - 7:08 AM
  • Boy Scouts’ Lawyers Eye New Reorganization Plan After Criticisms from Abuse VictimsApril 15, 2021 - 5:58 AM
  • White House Rushes to Strengthen Security of U.S. Power Grid as Hacking Threats GrowApril 15, 2021 - 5:25 AM
 

Maddox Insurance Agency

Insurance Agency in Memphis, Tennessee

Main Office

2151 Courtland Place | Memphis, TN 38104

Licensed in Tennessee, Mississippi & Arkansas

Contact

Phone: (901) 335-0154
Fax: (901) 255-9141

Lee.Maddox@maddoxinsured.com

Follow Us On

© 2021 Maddox Insurance Agency, All Rights Reserved. | Website Hosting by K.Tek Systems Inc.
  • Get Quote
  • Insurance Products
  • Contact
  • Home
Scroll to top