Content by Keyword: Insurance

The Health Insurance Marketplace will provide a new, simplified mechanism to obtain coverage in the individual market beginning in 2014. Families with household incomes between 100 to 400% of the Federal Poverty Level (FPL) who are not eligible for Medicaid or CHIP may qualify for new tax credits to make premiums more affordable. In addition, any

For plan or policy years beginning on or after January 1, 2014, non-grandfathered individual and small group market insurance plans must cover benefits in ten categories of services and items included in the definition of essential health benefits (EHBs).  The ten categories include: ambulatory patient services; emergency services; hospitalizatio

The Affordable Care Act (Section 2001) requires maintenance of the pre-Affordable Care Act Medicaid and CHIP eligibility levels for children 18 and younger through 2019. In addition, the Affordable Care Act requires all states to provide Medicaid coverage for children ages 6-18 with incomes at or below 133 percent of Federal Poverty Level Guidelin

An estimated 25 percent of all children between the ages of 12 and 17 have special health care needs. For example, about 11 percent of adolescents 12-17 have Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD) and 10 percent have asthma. 9    The Affordable Care Act (adding new Section 2704 to the Public Health Servic

Health promotion, disease prevention, early intervention, and timely treatment of conditions can improve the health status of adolescents and reduce the incidence of chronic conditions in adulthood.  The Affordable Care Act (adding new Section 2713 to the Public Health Service Act) seeks to make prevention affordable by requiring most private hea

The Affordable Care Act includes provisions intended to improve access to health insurance coverage and ensure that such coverage provides essential health benefits for adolescents and young adults. Several of these provisions are already in effect for most plans, including requirements to cover preventive services without cost-sharing, a prohibit

1 § 2794(c) of the Public Health Service Act, as added by § 1003 of the Patient Protection and Affordable Care Act, 42 U.S.C. § 18001 (2010). 2 45 C.F.R. 154.200 3 Beginning in 2014, regulations require states to report all rate increases, even though only increases of 10 percent or more are reviewed for “reasonableness.”

Rate Review Justification data are submitted to the Center for Consumer Information and Insurance Oversight (CCIIO) for rate requests of 10 percent or more. This analysis used only adjudicated requests with effective dates between January 1, 2012 and December 31, 2012.

HHS awarded State Rate Review Grants to states in September 2011 and September 2012.  States submitted data to HHS on rate increases for major medical policies in their individual and small group policies as part of their State Rate Review Grant requirements. The Rate Review Grant (RRG) database consists of state quarterly submissions, from 201

The rate review provisions of the Affordable Care Act are building the foundation for a health insurance marketplace where consumers can make informed choices and insurance companies are held accountable for unreasonable rate increases.  Requests for rate changes are now public information, and issuers must provide a justification for requested

Between 2010 and 2012, 47 states, including the District of Columbia, received Rate Review Grants.  States are using Rate Review Grant funds to implement extensive enhancements to their rate review programs and increase publicly-available data.  One means of enhancing their programs was to institute rate review authority.  Between 2010 and

Approximately 28 percent of all 2012 individual market rate increase requests of 10 percent or more were modified by the issuer or rejected by the state (where the state had such authority). Figure 3

The Affordable Care Act authorizes HHS to focus special attention on rate increase requests that are potentially “unreasonable.”  By regulation, HHS has defined requested rate increases of 10 percent or more as the threshold triggering greater scrutiny. 8 Insurance companies requesting such an increase must submit, both to HHS and their sta

In the small group market, analysis of the information from 35 states indicates that the implemented rate increases are approximately 19 percent lower than the rates originally requested by insurance companies. 6   This difference equates to approximately $866 million in savings to consumers based on 2012 small group market premium data.  For t

Based on information from 39 states from the individual market, the estimated national average rate increase implemented in the individual market in 2012 is approximately 12 percent lower than the increase originally requested by insurance companies.  Based on 2012 individual market premium data for all states, this difference equates to about $

As part of the Rate Review Grants Program, HHS collects data on all rate increases, even those below 10 percent, from every state that received a grant. 3   Figure 1 summarizes the results for the individual health insurance market.  Figure 2 summarizes the results for the small group insurance market.

Regulations implementing the Affordable Care Act also require health issuers that seek a rate increase of 10 percent or more to submit, both to their state insurance regulator and HHS, a justification of the rate increase. 2   The request, justification, and determination of whether the requested increase is unreasonable, are public information p

The Affordable Care Act authorizes the Secretary to award grants to states for the purpose of improving their review of proposed rates in the individual and small group health insurance markets. 1   The law appropriates $250 million for rate review grants for a five year period, fiscal years 2010 through 2014.  Each state receiving a grant must

The Affordable Care Act continues to bring transparency and scrutiny to health insurance rate increases.  Because of the law, the Department of Health and Human Services (HHS), along with states, is working to hold insurance companies accountable by requiring them to document, submit for review, and publicly justify rate increases of 10 percent

1 This number, based on the 2011 American Community Survey (ACS), is the estimate of Americans who are citizens or legal residents under the age of 65 and therefore eligible for coverage either in the Marketplace or through Medicaid. Some of these were eligible for Medicaid or CHIP coverage prior to 2014 but were not enrolled. 2 Totals do no