Insurance Market Reform

These final regulations provide guidance to individual taxpayers on the liability for the shared responsibility payment for not maintaining minimum essential coverage.

This proposed rule provides guidance on the tax credit available to certain small employers that offer health insurance coverage to their employee, detailing eligibility for and calculating the tax credit. Comments on the rule are due by November 25, 2013.

Network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all health care services included under the terms of the contract. States have taken different approaches in regulating the adequacy of health plan networks based on their state-specific market, and states have a variety of options available to maintain robust health insurance markets by balancing access needs with the goals of controlling costs and attracting a healthy number of insurers. This brief, prepared by the Georgetown University Health Policy Institute, explores some of the discrepancies that can arise with varying network adequacy standards and provides examples of how some states have resolved such issues.

A number of states have recently released information on what premiums will be in the individual insurance market in 2014, when significant changes in that market take effect due to the Affordable Care Act (ACA). However, these premiums are in effect “sticker prices” that many people will not pay because they will be eligible for federal tax credits under the ACA to offset the cost of insurance. In this data note, we explain how the tax credits will work and estimate how much premium assistance people now buying their own insurance will be eligible for in 2014.

On June 28, the Departments of the Treasury, Labor, and Health and Human Services issued the final rules on the ACA requirements that health plans cover contraceptives for women with no cost-sharing. For employees of religious non-profits, insurers and third-party administrators will be required to provide contraceptives to employees. The final rule also provides further clarification on exemption of houses of worship from this requirement.