Insurance Market Reform

This proposed rule provides guidance on the annual fee that certain U.S. health insurers will be required to pay starting in 2014. It also clarifies the types of entities that are exempt from the fee, including self-insured employers, government entities, and certain nonprofit corporations and voluntary employees’ beneficiary associations (VEBAs).

HHS released its final rule on insurance market rules and rate view. This rule establishes an age-rating band of 3-to-1 for adults, which means that the rates for older adults cannot be higher than three times the rate being charged to younger adults, and HHS states it does not have the authority to phase-in this rating band. It also details the catastrophic plan available to younger adults and establishes the protections for individuals with pre-existing conditions.

In this FAQ on states’ involvement in plan management activities, HHS establishes that states can evaluate whether health plans and issuers meet certification standards and conduct other specified plan management activities without submitting a Blueprint.

This white paper from the Kaiser Family Foundation examines the various insurance market changes that may affect health insurance premiums for people buying nongroup insurance when the Affordable Care Act is fully enacted in 2014, including the higher level of benefits, the better protection against catastrophic costs, and wider access to coverage.

The Internal Revenue Services (IRS) released proposed rules explaining the ACA’s shared responsibility provision and the process for determining eligibility for and granting certificates of exemption from the shared provision.

The Centers for Medicare and Medicaid Services (CMS) released proposed rules explaining the ACA’s shared responsibility provision and the process for determining eligibility for and granting certificates of exemption from the shared provision.

This brief examines the three proposed federal regulations that detail how the ACA’s rules will operate in private insurance market reforms, essential health benefits and actuarial value, and wellness programs offered or required by employers under group health plans. 

This brief analyzes the factors behind increased spending on private insurance, examining trends in premiums and cost-sharing in the group and non-group markets, how premium dollars are spent by insurers, which sectors are driving premiums upward, and the importance of price increases in explaining spending growth.

This brief provides an overview of the federal guidelines around the EHB benchmark plans, which the states must submit by December 26, in addition to mapping out selections from the 26 states plus the District of Columbia that have already submitted their plans.

This proposed rule, released by the Deparment of Health and Human Services, addresses market reform regulation, covering guaranteed issue, community rating and rate review.