Marketplace
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Celebrating Health Care Gains Ushered in by Affordable Care Act
It’s been 13 years since the Affordable Care Act (ACA) was signed into law. At the time my daughter was in elementary school and I didn’t much think about what would happen to her health insurance – but now as she seems very grown up and is about to graduate from college and search for…
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The ACA’s Preventive Services Benefit Is in Jeopardy: What Can States Do to Preserve Access?
By Justin Giovannelli, Sabrina Corlette, and Madeline O’Brien, Georgetown University Center on Health Insurance Reforms A federal judge is poised to gut one of the most popular provisions of the Affordable Care Act (ACA). The ACA requires that most private health plans cover preventive services, such as certain cancer screenings and immunizations, without imposing cost sharing on…
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States Leading the Way on Connecting All Children with Health Coverage – Will Congress Follow?
According to the Urban Institute, over half of the remaining uninsured children are eligible for Medicaid or the Children’s Health Insurance Program (CHIP) but unenrolled. About a third of uninsured children are ineligible for Medicaid or CHIP because their family income exceeds the eligibility thresholds. Another 10% are ineligible for Medicaid/CHIP because of their immigration…
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What’s New for 2023 Marketplace Enrollment?
By Emma Walsh-Alker, Georgetown University Center on Health Insurance Reforms The annual open enrollment period for marketplace coverage is right around the corner. There are many new policies impacting the marketplace in 2023, including an extension of enhanced financial assistance through the Inflation Reduction Act; a federal fix to the “family glitch” that will create…
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Standards for Provider Network Adequacy in Medicaid and the Marketplaces
The Centers for Medicare & Medicaid Services (CMS) has issued final rules for provider network adequacy in Qualified Health Plans (QHPs) offering coverage in the Marketplaces that the federal government operates through HealthCare.gov. Under these rules, which come with the snappy title, “Notice of Benefit and Payment Parameters” and the even snappier initialism (NBPP), CMS…
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Updated Breast Pump Coverage Guidelines Provide Important Protections for Families But More Guidance May Be Needed to Increase Access
By Christine Monahan As a new mom to a seven-month old (hi Baxter!), I’ve been on a crash course in breastfeeding since he was born. I’ve quickly learned that breastfeeding isn’t easy and, despite the claims, it isn’t free. And I better understand why so few families meet the American Academy of Pediatrics (AAP) recommendation to feed infants only breastmilk for their…
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More Children Enrolled in ACA Marketplace Coverage in 2022, But Marketplaces Still Remain Modest Source of Health Coverage for Children
Medicaid and the Children’s Health Insurance Program (CHIP) currently cover more than 40 million children. In comparison, relatively few children rely on the marketplaces for their health coverage. But new data released by the Centers for Medicare & Medicaid Services (CMS) show 1.3 million children were enrolled in marketplace plans during the 2022 Marketplace Open…
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Medicaid Managed Care: What Can the Annual MLR Report Tell Us?
Over 32.8 million children are covered by Medicaid, and the large majority are enrolled by their state Medicaid agencies in managed care organizations (MCOs). In exchange for monthly capitation payments, the MCOs contract with the state Medicaid agency to furnish covered services through networks of providers. These arrangements, in 40 states and the District of…
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Build Back Better Act: Health Coverage Provisions Explained
On November 19, 2021, the House of Representatives passed the Build Back Better Act, the budget reconciliation bill, with the Senate expected to consider the legislation in coming weeks. The Build Back Better Act includes numerous provisions that would dramatically strengthen and expand both public and private health insurance coverage. Some of the new provisions…
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Three New State-Based Marketplaces Are Up and Running
By Rachel Swindle We’re a week into Affordable Care Act (ACA) marketplace open enrollment, and it looks like the three newest marketplaces, Kentucky, Maine, and New Mexico, are off to a solid start. These three states successfully transitioned this year from the federal marketplace platform, HealthCare.gov, to a full state-based marketplace (SBM). They join fourteen other states and the District…
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New and Improved Navigator Resource Guide Answers Common Enrollment Questions, Spotlights Innovative Outreach for Communities of Focus
November 1 marked the start of the Affordable Care Act’s eighth open enrollment season in most states. To help marketplace Navigators and others assisting consumers with marketplace eligibility and enrollment, we at CHIR have updated and improved our Navigator Resource Guide. The Guide is a practical, hands-on resource with over 300 frequently asked questions (FAQs) on topics such as marketplace eligibility, premium and…
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Misleading Marketing of Non-ACA Health Plans Continued During COVID-19 Special Enrollment Period
By Dania Palanker and JoAnn Volk Millions of Americans are eligible for health insurance plans with low or no premiums and significantly reduced cost-sharing this coming open enrollment period thanks to enhanced marketplace subsidies under the American Rescue Plan (ARP). But misleading marketing practices may direct some consumers to alternative plans that lack the Affordable Care…
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Build Back Better Reconciliation Bill Would Take Big Strides in Expanding Health Coverage and Access for Children and Families
[Editor’s Note: The U.S. House of Representatives approved a revised Build Back Better Act budget reconciliation bill on November 19, 2021. This brief by Georgetown University CCF and CHIR explain the Medicaid, CHIP, and private health insurance provisions.] Yesterday, the House Rules Committee unveiled a compromise reconciliation bill which includes numerous provisions that dramatically strengthen…
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What’s New for 2022 Marketplace Enrollment?
Open Enrollment is just around the corner. There are new policies for the marketplace in 2022, including an expansion of opportunities to sign up for health coverage during and outside the annual open enrollment period. There are also new opportunities to get financial help with the enactment of the American Rescue Plan (ARP) Act. Here…
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Building a Better Transparency Mousetrap: Recommendations to Optimize Hospital and Health Plan Price Disclosures
By Sabrina Corlette, Megan Houston, Maanasa Kona, Rachel Schwab, and Nia Gooding from the Center on Health Insurance Reforms at Georgetown University’s Health Policy Institute. High and rising health care costs are projected to consume 20 percent of the U.S. economy by 2027, squeezing workers’ wages, reducing our economic competitiveness, and forcing difficult budgeting decisions for federal and…
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Biden Administration Announces It Will Reopen Federal Marketplace Enrollment
Today, January 28, 2021, President Biden signed an executive order establishing a new special enrollment period for the Affordable Care Act’s marketplaces in most states, in order to increase health coverage during the COVID-19 pandemic. The special enrollment period will begin February 15, 2021 and run through May 15, 2021 and like the annual open…
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Open Enrollment FAQ of the Week: What Does My Plan Cover?
With Open Enrollment now well underway, consumers are weighing their options for 2021 and trying to find the right plan that meets their health needs. As consumers make their decision, it is important for them to understand what they are buying and what coverage their plan provides. Throughout the enrollment period, the Georgetown University Center…
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What’s New for 2021 Marketplace Enrollment?
By Megan Houston, Georgetown University Center on Health Insurance Reforms On November 1, the eighth open enrollment period begins for marketplace coverage under the Affordable Care Act. This year there are several policy changes that could have an impact on enrollment and affordability of plans on the marketplace including: COVID-19 Pandemic: The novel coronavirus (COVID-19) pandemic…
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New Report Provides State Policy Recommendations on How to Protect Consumers, Reduce Disparities During the COVID-19 Pandemic
The COVID-19 pandemic presents unprecedented threats to health and safety, and exacerbates existing inequities that continue to jeopardize the wellbeing of millions of Americans. As always, state health policy is critical to protecting consumers’ access to health care and addressing health disparities, particularly during the public health and economic crises brought by COVID-19. To help…
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Health and Racial Disparities for Babies, Mothers Need Focused Attention, New Report Finds
As we’re increasingly learning, the experience of preconception, prenatal, birth, and postpartum health for moms flows directly to their infants, setting up the health status of the young family in the critical first years of life. This is why ZERO TO THREE’s State of Babies report this year calls special attention to hurdles faced by…
