With major health insurers such as UnitedHealthcare, Aetna and Humana pulling out of the Affordable Care Act marketplaces, the Department of Health and Human Services took action to try to protect the remaining health plans from the risk of sicker than expected enrollees.
The agency issued a proposed rule that would make changes to the ACA’s risk adjustment program. Beginning in 2018, prescription drug use data would be included in the calculations to determine the payments insurers that cover sicker enrollees would receive from insurers that cover healthier enrollees.
Beginning in 2017, the risk associated with enrollees who aren’t enrolled for a full 12 months would be reflected. Those enrollees have proved to have higher health costs than people who stay enrolled in a plan for a full year.
“The ACA’s risk adjustment program plays an important role in ensuring that issuers have both the incentives and the financial support to design products to serve all Americans,” Marketplace Chief Executive Officer Kevin Counihan said in a blog posting.
Most health plans offered on the marketplaces have lost money because enrollees are sicker than insurers originally expected and the share of young adults, who are generally healthier than older people and cost less to cover, has not been as high as hoped.
The HHS also is proposing expanding standardized plans that include uniform cost-sharing requirements for consumers, which insurers have the option of offering. Further, a pilot program is being introduced in some states aimed at greater transparency of provider networks in health plans offered through the federal HealthCare.gov marketplace.
About 11.1 million people enrolled in the ACA marketplaces in 2016 and open enrollment for coverage in 2017 is to be held from Nov. 1 through Jan. 31, 2017.
For the entire story, go to http://www.bna.com/changes-health-plan-n73014447000/.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to email@example.com.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to firstname.lastname@example.org.
Put me on standing order
Notify me when new releases are available (no standing order will be created)