The Georgetown University’s Center on Health Insurance Reforms recently released an issue brief entitled “Specialty Tier Pharmacy Benefit Designs in Commercial Insurance Policies: Issues and Considerations.” A prescription drug benefit can be especially important for people with disabilities as they are considering their options in qualified health plans. This issue brief draws attention to how insurance companies have started treating prescription […] Read More »
Understanding the Implications of Re-enrollment
Are you trying to understand the implications for how the federal government proposes to handle re-enrollment in the federally facilitated exchanges? Automatic re-enrollment at the previously determined Advanced Premium Tax Credit (APTC) will occur for the large majority of consumers in the federal marketplace, but this proposal could have significant impact on those consumers who […] Read More »
What States Have Released Exchange Plan Rates for 2015
If you’re wondering if your state has released information on premium rates for qualified health plans in 2015, be sure to check out the resource map from the State Refor(u)m run by the National Academy for State Health Policy. As of the writing this post, 12 states plus DC have released information: Colorado, Connecticut, District […] Read More »
Understanding Grace Periods
Do you know a consumer who has missed some premium payments? While many navigators know that coverage does not fully begin for a consumer until they make their first premium payment, you may not know that a carrier cannot immediately cancel a plan if a consumer misses one or more premium payments. In this week’s […] Read More »
Court Cases on Premium Tax Credits
On Tuesday of this week, two conflicting court decisions were handed down on the legality of the Premium Tax Credits in the federally facilitated marketplaces. As a result, navigators and assisters may start receiving questions about consumers’ tax credits or they may encounter people asking questions about these cases when open enrollment begins again this […] Read More »
New Resources on the NDNRC
As a follow-up to last week’s Enroll America Conference, we’ve added several resources to the NDNRC website. These include Enroll America’s “State of Enrollment Report,” “Certified Application Counselor Program: Early Lessons” issue brief and “Fast-Track Medicaid Enrollment Saves States Money” issue brief. Another new resource is an issue brief from Georgetown University’s Health Policy Institute […] Read More »
New MAGI Resources
Do you have questions about MAGI calculation for eligibility determinations? We recently added new resources to assist navigators and enrollment specialists understand MAGI and its effect on eligibility determinations for Medicaid, CHIP and Premium Tax Credits. CMS has released two flowcharts to assist with these determinations and they can be accessed here and here. Additionally, the […] Read More »
Summary of Final Rules for 2015 Marketplace
Last week, we referenced the new regulations that were released by the Centers for Medicare & Medicaid Services. Families USA has prepared a succinct explanation of how these roles impact navigators and enrollment specialists. Their explanation of the final regulations is as follows: Specifies several types of state requirements that would conflict with federal requirements […] Read More »
Individuals with Pre-Existing Conditions May Be Entitled to a SEP
Individuals who had pre-existing conditions and were enrolled in the Pre-Existing Condition Insurance Plan (PCIP) are now eligible for a special enrollment period (SEP). PCIP was a plan put in place by the Affordable Care Act for individuals who had pre-existing conditions and had previously been unable to obtain health insurance due to those pre-existing […] Read More »
Churning – What is It & What Do I Need to Know?
Now that the open enrollment period has closed completely, it’s time to discuss the circumstances of individuals that will come up during the year that will affect their eligibility for special enrollment periods (SEPs). One of the more unique situations that can occur is referred to as “churning.” This is when an individual’s income fluctuates […] Read More »