Insurance Exchanges

The U.S. Office of Personnel Management (OPM) issued a proposed rule to implement modifications to the Multi-State Plan (MSP) Program based on the experience of the program to date. This proposed rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers that contract with OPM to offer MSP options. This proposed rule amends MSP standards related to coverage area, benefits, and certain contracting provisions under section 1334 of the Affordable Care Act. This document also makes non-substantive technical changes.
 

This report analyzes the public education and application assistance strategies employed during the 2014 open enrollment period based primarily the Health Reform Monitoring Survey (HRMS) and interviews with diverse informants in 24 states.  In addition to describing general trends involving public education and application assistance, this analysis shares promising practices used by particular states as well as suggestions offered by stakeholders and researchers. Such practices and suggestions focus primarily on state-based and partnership marketplaces, but many could also apply to federally-facilitated marketplaces.
 

All qualified health plans under the ACA must cover a package of essential health benefits (EHBs) equal in scope to a typical employer plan. The law laid out 10 general categories of services that EHBs must cover, but did not itemize those services. As an interim policy for 2014 and 2015, the Department of Health and Human Services allowed each state to identify an existing plan as a benchmark for these EHBs. The result of this policy is that EHBs vary from state to state, often because of a legacy of different state-mandated benefits (such as treatments for autism, infertility, or temporomandibular joint disorders). This brief analyzes state variation in coverage and limits for these non-uniform benefits.
 

To help enrollees new to the system keep their insurance, the ACA provides a ninety-day grace period before an insurer can discontinue someone's coverage for failure to pay a monthly premium. This applies only to those who have received an advance premium tax credit to purchase health insurance through the Marketplaces and have previously paid at least one month's full premium in that benefit year. This Health Policy Brief focuses on CMS's implementation of the ACA grace period and concerns from hospitals and physicians about potential financial liability now that millions of people have signed up for subsidized health insurance on the Marketplace exchanges.
 

This new report captures insights from those who helped consumers navigate the ACA’s first open enrollment period, including lessons for the second, which is set to start Nov. 15. The report draws on the experiences of 80 program leaders who participated in a roundtable discussion convened by the foundations in June. The group talked about consumer education and engagement, options for improving consumer notices and technical support for assisters, ways to better help people make informed choices, and the need to continue assisting consumers after enrollment.