CMS
Posted April 18th, 2017 in Producers, Employers, Individuals
On April 13th, the Centers for Medicare and Medicaid Services (CMS) finalized rules which aim to stabilize Exchanges and the individual marketplace. There are five key takeaways from the new rules:
Posted December 20th, 2016 in Producers, Employers, Individuals
The health insurance industry saw quite the year in 2016. Here are some of the highlights:
- ACA reporting had to be submitted for the first time which was an administrative struggle for several employers, but most were able to find a way to get it completed.
- Several Co-Ops, including Land of Lincoln Health, were forced to shut down due to solvency problems.
- Most insurers reduced or eliminated commissions on the sale of individual health insurance plans as a result of profit losses.
The Internal Revenue Service (IRS), Social Security Administration (SSA), and the Centers for Medicare & Medicaid Services (CMS) are required to share information that each agency has about whether Medicare beneficiaries or their spouses are working. This sharing of information is referred to as the IRS-SSA-CMS Data Match, and the purpose of the Data Match is to identify situations where another group health plan may be primary to Medicare. In general, a group health will be primary to Medicare when:
As required under the ACA, the federal government must conduct audits of Marketplace coverage to ensure that only people who are truly eligible are receiving a subsidized plan.
Effective Spring 2016, CMS launched an "Employer Initiatives" Program to aid in the auditing process. As part of this program, CMS may contact an employer to request whether or not one or more employees were enrolled in minimum essential coverage, or whether or not they were offered a health plan which was affordable and had minimum value.
The Centers for Medicare and Medicaid Services (CMS) unveiled a new interim final rule on May 6, 2016 which amends certain special enrollment periods (SEPs) in the individual marketplace and revises certain rules pertaining to consumer operated and oriented plans (CO-OPs). The rule aims to curb abuse of the SEP, which insurers have said is occurring when consumers claim to have a qualifying event but actually do not. The rule also aims to strengthen the CO-OP program.
Posted February 26th, 2016 in Producers, Employers, Individuals
The Centers for Medicare and Medicaid Services (CMS) recently announced a new process that will impact anyone seeking to enroll with a special enrollment period (SEP) on the Healthcare.gov website. Under the current process, individuals who experience a qualifying event simply need to check a box on the application to be eligible for an SEP.
Posted January 29th, 2016 in Producers, Employers, Individuals
Insurance companies are concerned that some people are abusing the Special Enrollment Period (SEP) that is available in the individual marketplace. They have indicated at least some people are delaying enrollment in coverage until they get sick, applying for coverage only once they need it, and then canceling the coverage after treatment. They further argue that there aren’t enough rules in place to verify if a person actually experienced a qualifying event which would trigger a SEP.
Posted December 10th, 2015 in Producers, Employers, Individuals
Below is a list of some key Affordable Care Act (ACA) changes and facts that will be effective in 2016:
- The Individual Mandate penalties increase to $695 per adult ($347.50 per child) or 2.5% of household income, whichever is greater.
- The Employer Mandate expands to include all employers who have 50 or more employees.
- The Employer Mandate offer rate increases from 70% to 95%.
- Employer reporting related to the offer of coverage is due for the first time during Q1 2016.
You may have thought the penalty for applicable large employers who fail to offer minimum essential coverage was $2,000 per employee. You may have also thought that if you offered coverage, but it was unaffordable and/or didn’t provide minimum value, then the penalty was $3,000 per employee who waived coverage and received a subsidy in the Exchange.
Posted November 20th, 2015 in Producers, Employers, Individuals
The Centers for Medicare and Medicaid Services (CMS) has released premium and cost sharing information for Medicare beneficiaries in 2016. Approximately 70% of individuals will pay $104.90 per month for Part B, however, the premium cost will be higher for the remaining 30% of individuals who:
- Enroll in Part B for the first time in 2016; or
- Those who don’t currently receive Social Security benefits; or
- People who have Medicare and Medicaid, and Medicaid pays the Part B premium; or
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