CMS

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.

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:
 
  1. The Individual Mandate penalties increase to $695 per adult ($347.50 per child) or 2.5% of household income, whichever is greater. 
  2. The Employer Mandate expands to include all employers who have 50 or more employees. 
  3. The Employer Mandate offer rate increases from 70% to 95%. 
  4. Employer reporting related to the offer of coverage is due for the first time during Q1 2016. 
Posted November 25th, 2015 in Producers, Employers

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:
 
  1. Enroll in Part B for the first time in 2016; or
  2. Those who don’t currently receive Social Security benefits; or
  3. People who have Medicare and Medicaid, and Medicaid pays the Part B premium; or
Posted October 14th, 2015 in Producers, Employers

The 2016 Medicare Part D annual enrollment period will begin on October 15, 2015 and run through December 7, 2015. Medicare beneficiaries can enroll in a Part D drug plan or make changes to existing coverage during this time period. Enrollment can be done through a stand-alone drug plan or a Medicare Advantage plan that integrates coverage for medical and drug expenses.      

Posted January 3rd, 2014 in Producers, Employers, Individuals

President Obama had previously announced that individuals could keep their health plan for another year if they received a cancellation letter in the mail. But he ultimately left this decision up to each state to decide. There were several states that chose not to allow these health plans to be continued for another year. As a result, several individuals are being forced to find new coverage.

Posted September 27th, 2013 in Producers, Employers, Individuals

The Center for Medicare & Medicaid Services (CMS) released proposed regulations about a new Basic Health Program that will be available starting in 2015. The Basic Health Program will be a lower cost alternative for people that cannot afford health plans in the insurance exchanges, such as those people that fall just outside of Medicaid eligibility. 

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