Benefits & Services
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HHS Proposes EHB Rule Changes
By Joe Touschner Though the Institute of Medicine, the administration, and many states spent more than a year developing the essential health benefits, the resulting approach was intended to be temporary. The “benchmark plan” method for choosing the EHBs initially applied to plan years 2014 and 2015, with a review of the approach promised for…
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Essential Health Benefits Across the States
By Joe Touschner Who remembers the essential health benefits? It was more than two years ago when JoAnn Volk filled us in on the plans states were choosing as their benchmarks to help set the minimum benefits in individual and small group market plans. More recently, Wakely Consulting offered a very helpful comparison of benefits…
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Fulfilling the ACA’s Promise
There is no doubt that families are much better off than they were before the Affordable Care Act (ACA) was enacted. Young adults, the most likely age group to be uninsured, can stay on their family’s health plan. Children with cancer will no longer exceed their annual limit on costs or max out their lifetime…
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Two States On the Path to the Basic Health Program
Both Minnesota and New York are on the path to setting up a Basic Health Program (BHP) that will provide more affordable coverage for low-income families than they may find on the marketplace. Minnesota passed BHP legislation that was signed into law in May 2013. In New York, BHP was included in the Governor’s budget…
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Time for a Dental Check-up
By Joe Touschner As families have signed up for new marketplace coverage over the past several months, many questions have come up around dental benefits. I wanted to pass along some useful resources for understanding 2014 plans as well as the latest news on how marketplace dental plans will change for 2015. First, just in…
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Women are Finally Receiving More Equitable Treatment When Shopping for Health Insurance
By Sarah Dash, Georgetown University Center on Health Insurance Reforms On a recent frosty morning, an article caught my eye. Like the never-ending snowstorms in the movie Frozen, it was another in a series of news stories chronicling worries about whether certain groups of people – in this case, women – are going to destabilize the risk pool…
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One Step Closer to the Basic Health Program
While many of us have our focus on health coverage that begins on January 1, 2014, I am also keeping my eye on a new option for states to provide more affordable coverage to low-income parents and other adults that starts on January 1, 2015. Right before Thanksgiving, we filed comments on the Basic Health…
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More Clarity on When Medicaid is Minimum Essential Coverage
By Joe Touschner Minimum essential coverage (not to be confused with the essential health benefits) is an important concept in the Affordable Care Act. Those who have minimum essential coverage (MEC) satisfy the individual responsibility requirement, that is, they meet the ACA’s individual mandate to have health insurance. Those who don’t have MEC other than…
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Emerging Policies on Dental Coverage for Kids
By Joe Touschner With the final rule on EHBs, another on market reforms, and some additional guidance from HHS, we’re getting a clearer picture of how one important set of benefits—dental care—will work for kids in EHB-covered plans next year. As readers know, those are new private plans in the individual and small group market. …
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Final Essential Health Benefits Rule Unveiled
By Joe Touschner It’s been a long process involving an in-depth study, state choices, and stakeholder comment on multiple rounds of proposals from HHS, but we now have the final essential health benefits rule. Along with it came final rules on actuarial value for QHPs and cost-sharing limits in many types of private health coverage.…
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Essential Health Benefit and Market Reform Rules Comments Are Due December 26th – CCF Shares Draft Comments
By Joe Touschner In my last post on HHS’s proposed rules, I mentioned that, like the holidays, the comment deadline would be here before we knew it. Well here we are in the middle of the holiday season and the December 26 deadline is right around the corner. It’s likely not something that was on…
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Essential Health Benefit Regs Invite Comment, Provide New Info on Habilitative Services and Cost-Sharing
By Joe Touschner As we noted just before Thanksgiving, HHS recently proposed regulations on essential health benefits (as well as cost-sharing and actuarial value). A few new developments are noted below, but the most important aspect of the rule is its opportunity for comment. Included with the rule is a proposed set of essential health…
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HHS Proposes Official Essential Health Benefit and Insurance Market Regulations
By Joe Touschner While HHS outlined its approach for setting Essential Health Benefits in a Bulletin nearly a year ago, we’ve been waiting for federal regulations to make things official. This week, those regulations were proposed. The Department has posted info on the regs at these links: EHB Fact Sheet EHB Proposed Rule We’re still…
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Where do States Stand on Affordable Care Act’s Essential Health Benefits?
By Joe Touschner As shocking as it may seem, the end of the year is less than 90 days away. That’s right, we’re in the fourth quarter, the one that includes Halloween, Thanksgiving, the holiday season, and New Year’s Eve. The third quarter wrapped up at the end of September, and with it the time…
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Waiting for 2014: One Family’s Story
How the ACA’s essential health benefits may help Henry get the health care he needs to grow and thrive. By JoAnn Volk, Georgetown University Center for Health Insurance Reform Losing health care coverage just before your due date is not something you read about in “What to Expect When Expecting.” Who would expect to lose…
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Lack of Dental Care Poses Health Risk to Children
By Tara Mancini Dental cavities are the most prevalent chronic disease among children. Many children are not able to obtain the dental care they need due to cost barriers, a shortage of dental health professionals in their area or for other reasons. According to an Institute of Medicine (IOM) report, as many as 4.6 million…
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CCF and Children’s Dental Health Project Release New Pediatric Dental Benefits Brief
By Joe Touschner As Tara Mancini has observed, more and more of us in the health care world are coming to the stunning realization that the mouth is part of the body. To care for kids’ health properly, we need to give them quality, effective oral health services. The ACA recognizes this: it makes pediatric…
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State of the States: California and Colorado Identify EHB Benchmark
By Max Levin, Georgetown Center on Health Insurance Reform On Thursday, August 30, California passed legislation establishing the Kaiser Small Group HMO 30 plan as the state’s essential health benefits benchmark plan. Beyond identifying the state’s benchmark plan, the legislation appears to include a number of important consumer protections by, for example, prohibiting plans from…
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Pediatric Dental Benefits Under the ACA: Issues for State Advocates to Consider
By Joe Touschner The Georgetown University Center for Children and Families and the Children’s Dental Health Project collaborated to produce this issue brief. It presents an overview of some of the key changes the Affordable Care Act makes to children’s dental benefits and the choices states face in defining pediatric dental benefits. It concludes with recommendations for those who wish to support…
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State of the States: Choosing an Essential Health Benefits Benchmark
By JoAnn Volk, Center on Health Insurance Reforms To help make coverage more comprehensive, the Affordable Care Act (ACA) requires insurers to cover a minimum set of health insurance benefits, known as “essential health benefits.” Consumers are already benefitting from this new protection: beginning in 2010, the ACA prohibits insurers from imposing lifetime or annual…