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Posted January 16th, 2018 in Producers, Employers, Individuals
In a letter sent to state Medicaid Directors on Thursday, the Trump Administration announced that it would allow states to impose work requirements to qualify for Medicaid. States will have the flexibility to design their work requirement eligibility structure, but they must submit details to the Centers for Medicare and Medicaid Services (CMS) for approval. 
 
Posted December 12th, 2017 in Producers, Employers, Individuals
We haven’t even gotten through the 2018 open enrollment season yet, but the Centers for Medicare and Medicaid Services (CMS) has already proposed rules that would impact health insurance markets for 2019. Each year, CMS issues a Notice of Benefit and Payment Parameters which explains various rules, inflation adjustments and other changes that will occur with the implementation of the Affordable Care Act (ACA).
Posted October 3rd, 2017 in Producers, Employers, Individuals
Each year employers must provide a written notice to Medicare-eligible employees who are covered under their group health plan. The notice must include information about the creditable coverage status of the prescription drug benefit. In other words, the notice tells employees if the prescription drug benefit on the group health plan is at least as good as the standard Medicare Part D plan. 
 
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:
 
  1. 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.
     
  2. Several Co-Ops, including Land of Lincoln Health, were forced to shut down due to solvency problems. 
     
  3. Most insurers reduced or eliminated commissions on the sale of individual health insurance plans as a result of profit losses.
     
Posted July 22nd, 2016 in Producers, Employers
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:
 
Posted May 23rd, 2016 in Producers, Employers
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. 
 
Posted May 16th, 2016 in Producers, Employers
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.