News

Insurers worry ACA loophole could lead to unpaid premiums, bad debt

Thanks to a loophole in the Affordable Care Act regulations, insurers worry customers who purchased plans on the federal marketplace could evade paying their December premiums, reports Vox.

Consumers continue to flock to HealthCare.gov

Open enrollment has come and gone but new federal data, obtained by ProPublica, shows the federal exchange saw roughly 1 million insurance transactions since mid-April.

MLR rebates total $9B

Insurers have paid consumers a total of $9 billion since 2011 under the medical-loss ratio, the U.S. Department of Health and Human Services announced today.

Cut prescription drug prices to achieve Medicare savings

Given the recent surge in pricey prescription drugs, lawmakers are calling for Medicare to offer rebates and negotiate prices to reap significant savings, according to a report released Wednesday by advocacy groups the Medicare Rights Center and Social Security Works.

Subsidy rulings mean more enrollment work for insurers

Given the opposing opinions coming out of two separate court rulings regarding Affordable Care Act subsidies, there's bound to be confusion among consumers interested in signing up for coverage during the next enrollment period.

How payers can eliminate consequences of provider consolidation

Although insurers and industry organizations often assert that provider consolidation leads to higher prices, some experts believe the impact is relatively neutral, reported Insurance News Net.

GAO: Fake ACA applicants secure subsidized coverage

Government investigators have been able to purchase health plans and obtain federal subsidies using fake applicantions, according to findings that will be released today, reports The Washington Post.

Tug-of-war develops over essential benefits

Starting this year, all insurers must provide certain essential health benefits as required under the Affordable Care Act. However, business groups are calling for restructured benefits while consumer advocates are pushing to uphold the coverage requirements, Kaiser Health News reported.

States on board with HSAs for Medicaid

Some states may implement health savings accounts (HSA) for their Medicaid programs next year, reports NPR.  Michigan and Indiana already allow beneficiaries to use funds supplemented by the state to pay for services and require monthly contributions to their health independence accounts.

3 ways an innovative medical clinic can benefit insurers

One medical clinic may single-handedly transform how primary care is delivered--and insurers could benefit by taking notice. In a post on LinkedIn, Elizabeth Bierbower, president of Humana's employer group segment, wrote about her experience while visiting Iora Health's Freelancers Clinic in Brooklyn, New York.

Appeals courts disagree on whether ACA subsidies are legal

In only one day, the Obama administration suffered a potentially huge loss followed by a victory regarding the legality of Affordable Care Act subsidies and whether consumers buying coverage through the federal health insurance exchange can receive financial assistance.

Study: Multipayer medical home only reaped limited improvements

A multipayer patient-centered medical home pilot in Pennsylvania led to only limited improvements in quality and failed to reduce unnecessary medical utilization, according to an article published in the Journal of the American Medical Association.

Lawmakers raise suspicions about HealthCare.gov contractor

During the troubled rollout of the HealthCare.gov website--glitches, delays and errors--the Obama administration hired technology company Quality Software Systems Inc. to rid the site of its problems. Yet because its sister company, UnitedHealthcare, sells plans on the marketplaces, many congressional Republicans are questioning the decision to enlist help from the tech firm, reports The Daily Signal.

States fight against provider consolidation

As providers continue to team up, insurers claim the growing rate of provider consolidation leads to high healthcare costs. Many states want to lessen the impact of provider consolidation by implementing laws and regulations that encourage price disclosure and ensure limits on healthcare prices, according to a new paper from the National Academy of Social Insurance and Catalyst for Payment Reform.

Few consumers have seen quality data for providers, survey finds

Although consumers say they value high-quality care and are willing to pay more to see high-quality doctors, few have actually done so, according to a new survey conducted by the Associated Press-NORC Center for Public Affairs Research.

Why Medicare Advantage should function like exchanges

If Medicare Advantage plans had to compete for members like plans sold on the health insurance exchanges, insurers could provide high value at lower costs, reported the New York Times.

Narrow networks: Striking the right balance

Interest in narrow networks has grown along with concerns about limited provider choice and treatment disruptions. To eliminate those issues, narrow networks must achieve a balance among value, access and affordability, industry leaders said Monday at a briefing from the nonpartisan Alliance for Health Reform in the District of Columbia.

Development problems continue for exchanges

There appears to be no evidence that the vendors for the Centers for Medicare & Medicaid Services have written the code to fix the faulty back-end systems that deal with paying subsidies and billing qualified health plan enrollees.

4 ways insurers can implement mobile performance metrics

Mobile app performance in the health insurance industry continues to gain importance and popularity. And as insurers embrace mobile strategies, it's imperative to measure their performance against cost and success at achieving business goals, FierceMobileHealthcare previously reported. Listed below are a few ways to implement and operate mobile performance metrics, according to Insurance & Technology.

New standards could expand provider networks

As health insurers' provider networks get more narrow, many states are adopting standards to ease consumer concerns about limited selections of doctors and hospitals, reports The New York Times.