October 2023

The 2024 ACA Open Enrollment Period (OEP) is STILL ongoing in 49 states +DC.

This is the best OEP ever for the ACA for several reasons:

• The expanded/enhanced premium subsidies first introduced in 2021 via the American Rescue Plan, which make premiums more affordable for those who already qualified while expanding eligibility to millions who weren't previously eligible, are continuing through 2025 via the Inflation Reduction Act;

• A dozen states are either launching or expanding their own state-based subsidy programs to make ACA plans even more affordable for their enrollees;

• Millions more Americans who weren't previously eligible for ACA subsidies (even with the expanded ARP/IRA enhancements) are now eligible via the Biden Administration's closure of the so-called "Family Glitch."

And remember, millions of people will be eligible for zero premium comprehensive major medical policies.

If you've never enrolled in an ACA healthcare policy before, or if you looked into it a few years back but weren't impressed, please give it another shot now. Thanks to these major improvements it's a whole different ballgame.

Here's some important things to know when you #GetCovered for 2024:

via the Centers for Medicare & Medicaid Services (CMS):

Today, the Biden-Harris Administration (the Administration), through the Departments of Health and Human Services (HHS), Labor, and the Treasury (the Departments), along with the Office of Personnel Management (OPM), released a proposed rule on the No Surprises Act’s Federal independent dispute resolution (IDR) process.

via the NJ Dept. of Banking & Insurance:

 Funding supports free tailored assistance to residents looking for coverage through the state’s official health insurance marketplace, Get Covered New Jersey 

TRENTON — Governor Phil Murphy and Department of Banking and Insurance Acting Commissioner Justin Zimmerman announced today $5 million in Navigator grants awards to 26 community organizations to assist in enrolling uninsured and underinsured New Jersey residents in health coverage through Get Covered New Jersey, New Jersey’s Official Health Insurance Marketplace during the Affordable Care Act Open Enrollment Period and throughout the year. The 2023-2024 Open Enrollment Period starts November 1st.

The grant-funded health insurance Navigators will provide free outreach, education, and enrollment assistance to residents shopping for health insurance and help them apply for financial help.

Via the Centers for Medicare & Medicaid Services (CMS):

Consumers continue to have more choices and stable premiums 

The Biden-Harris Administration believes health coverage is a right, not a privilege, and is committed to investing in a robust Marketplace Open Enrollment campaign so everyone who needs health coverage can easily sign up for it. Starting today, HealthCare.gov consumers can preview their health care coverage options and see detailed information about 2024 health insurance plans and prices offered in their area ahead of the Open Enrollment period that begins November 1. 

As we begin the 11th Open Enrollment period, the Marketplace is stronger than ever with lower out-of-pocket premiums thanks to the continuation of enhanced financial assistance under the Inflation Reduction Act. Thanks to the Inflation Reduction Act, nearly 15 million Americans are saving an average of $800 a year on their health insurance premiums.

via Maryland Health Connection:

MARYLAND HEALTH CONNECTION HOSTS HISPANIC HEALTH ACCESS ROUNDTABLE

• In Celebration of Hispanic Heritage Month, MHC Engages in Community Initiatives to Empower Community

BALTIMORE (Oct. 20, 2023) – Maryland Health Connection continues to demonstrate its commitment to fostering health equity and improving access to coverage for all communities, including the Hispanic community as Hispanic Heritage Month wraps up and Open Enrollment approaches. In a collaborative effort to engage and inform the Latino community, Maryland Health Connection hosted the Hispanic Health Access Roundtable on Oct. 17, at the Montgomery College Rockville Campus.

I debated how to word the headline for this blog post. On the one hand, the press release itself includes some important information and some genuinely good news re. cost savings for Colorado residents. On the other hand, I couldn't get past how hilariously misleading the headline itself is, so I decided to use the sublede instead.

Via the Colorado Department of Regulatory Agencies:

Gov. Polis and DOI Announce 80% of Health Insurers to Decrease Premium Requests for 2024 and Increases Reinsurance Savings to $411M for Colorado Consumers

• Nearly 20,000 more Coloradans could reduce deductibles to as low as $100.

DENVER - When it comes to health insurance, the Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), makes sure that insurance companies are complying with the Affordable Care Act (ACA), as well as State law and our specific insurance regulations. Today, Governor Polis and the Division of Insurance announced 80% of health insurers will decrease premium requests for 2024.

Last month I noted that Michigan legislative Democrats were planning on passing a package of bills designed to repeal a bunch of restrictions on abortion & other reproductive healthcare:

Via Paul Egan of the Detroit Free Press:

Dems to end 24-hour abortion waiting period, ban on Medicaid funding of procedure

LANSING — Michigan Democrats said Wednesday they will repeal laws that require a 24-hour waiting period to have an abortion performed, impose what they say are costly and unnecessary regulatory burdens on abortion clinics, prohibit abortions funded by Medicaid, and ban private health insurers from automatically covering abortions under standard policies.

via the Centers for Medicare & Medicaid Services (CMS):

October 16th: CMS approved a state plan amendment for Montana to extend postpartum coverage for a full year for individuals enrolled in Medicaid. The opportunity to extend postpartum coverage was made possible under the American Rescue Plan and made permanent in the Consolidated Appropriations Act, 2023. Montana’s approval marks 38 states, D.C., and the U.S. Virgin Islands that have extended postpartum Medicaid coverage for an entire year. This approval supports the CMS Maternity Care Action Plan and Biden-Harris Maternal Health Blueprint.

via KFF, the 12 states which haven't expanded postpartum Medicaid coverage to a full year include:

Via MNsure:

ST. PAUL, Minn.—Minnesotans who need health insurance for 2024 can now preview plans through MNsure, Minnesota’s official health insurance marketplace. MNsure’s annual open enrollment period for health insurance begins November 1, and Minnesotans can get a jump start by going to MNsure.org to shop, compare options, and get a free and anonymous cost estimate.

“MNsure is the only place Minnesotans can compare health plans from multiple insurance companies, side-by-side,” said MNsure CEO Libby Caulum. “When you shop for health insurance through MNsure, you can be confident you’re getting the right plan, at the right price, for you and your family.”

With just three key pieces of information — where you live, who is in your household, and total household income — you can get an immediate estimate of how much money you could save by enrolling in a private health plan for 2024 through MNsure. And you can find out if any household members may be eligible for no- or low-cost coverage through Medical Assistance or MinnesotaCare.

via the Centers for Medicare & Medicaid Services (CMS):

On October 12, 2023, the Centers for Medicare & Medicaid Services (CMS) released the 2024 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2024 Medicare Part D income-related monthly adjustment amounts. 

The Medicare Savings Programs (MSPs) help more than 10 million people with coverage of Medicare premiums and, in most cases, other cost sharing. In their continued efforts to improve access to health care and lower costs for millions of Americans, the Department of Health and Human Services (HHS), through CMS, recently finalized a rule to streamline enrollment in MSPs, making coverage more affordable for an estimated 860,000 people. In addition, the Part D low‑income subsidy (LIS) helps pay for the Part D premium and lowers the cost of prescription drugs. Further, the Inflation Reduction Act recently expanded the number of people eligible for full LIS.  

Medicare Part B Premium and Deductible

Until October 2013, I wasn't a healthcare wonk. I wasn't an expert on the ACA specifically or health insurance in general. I didn't know my ass from a hole in the ground when it came to risk pools, cost sharing, deductibles, out of pocket caps, guaranteed issue, community rating or any of the other industry buzz words.

Hell, I didn't even know that Medicaid is the same program as California's Medi-Cal or Wisconsin's BadgerCare Plus (that's just how those states brand the program).

What I did know was that the Patient Protection & Affordable Care Act, which had been signed into law 3 1/2 years earlier, was a Big Fucking Deal®, as President Biden had put it...and I knew that the main provisions of the ACA were about to go into effect.

Ten days earlier, on the same day that the federal and state ACA exchanges had opened for business (with some of them, including the main one at HealthCare.Gov experiencing catastrophic technical failures), At the same time, Texas Senator Ted Cruz had spearheaded a federal government shutdown (sound familiar?) in protest of the new law.

Those first few weeks were pretty chaotic for the ACA, to put it mildly.

This actually happened way back in January, but I didn't stumble upon the press release until now:

Shaheen Reintroduces Legislation to Lower Health Care Costs & Expand Access to Insurance for Millions More Americans

• Provisions of the Improving Health Insurance Affordability Act were signed into law through the Inflation Reduction Act & the American Rescue Plan Act
• Estimates suggest 8.9 million Americans have lower premiums thanks to enhanced tax credits
• **Shaheen’s efforts mark the most significant update to Affordable Care Act in a decade

(Washington, DC) – U.S. Senator Jeanne Shaheen (D-NH) today reintroduced her legislation, the Improving Health Insurance Affordability Act. The bill would make permanent enhanced tax credits that led to record Marketplace enrollment, while reducing health care costs for millions of additional Americans.

New York's implementation of the ACA's Basic Health Plan provision (Section 1331 of the law) is called the Essential Plan. It currently serves over 1.1 million New Yorkers, or over 5x as many residents as ACA exchange plans do.

Whenever I write about BHPs I always throw in a simple explainer about what it is, with an assist from Louise Norris:

Under the ACA, most states have expanded Medicaid to people with income up to 138 percent of the poverty level. But people with incomes very close to the Medicaid eligibility cutoff frequently experience changes in income that result in switching from Medicaid to ACA’s qualified health plans (QHPs) and back. This “churning” creates fluctuating healthcare costs and premiums, and increased administrative work for the insureds, the QHP carriers and Medicaid programs.

The out-of-pocket differences between Medicaid and QHPs are significant, even for people with incomes just above the Medicaid eligibility threshold who qualify for cost-sharing subsidies.

SEE IMPORTANT UPDATES AT BOTTOM.

Yesterday I crunched the numbers for two different reports from the Centers for Medicare & Medicaid services.

The first was the standard monthly Medicaid/CHIP enrollment report for June 2023:

In June 2023, 92,614,205 individuals were enrolled in Medicaid and CHIP.

• 85,614,581 individuals were enrolled in Medicaid in June 2023, a decrease of 1,169,095 individuals (1.3%) from May 2023.
• 6,999,624 individuals were enrolled in CHIP in June 2023, a decrease of 32,449 individuals (0.5%) from May 2023.

As of June 2023, enrollment in Medicaid and CHIP has decreased by 1,304,004 since March 2023, the final month of the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA) and amended by the Consolidated Appropriations Act, 2023.

Originally published 8/07/23

The good news is that RateReview.HealthCare.Gov has posted the preliminary 2024 rate filing summaries for every state, making it much easier to pin down which carriers are actually participating in the individual & small group markets next year, as well as what the carriers average requested rate changes are in states which don't publish that data publicly (or which make it difficult to track down if they do).

The bad news is that in many of those states, acquiring the actual enrollment data is even more difficult, as their rate filings tend to be heavily redacted. Alabama falls into this category.

Via MNsure:

Enrolling Through MNsure Offers Great Savings on 2024 Health Insurance Plans

ST. PAUL, MN — Starting November 1, Minnesotans who need health insurance can sign up for 2024 coverage through MNsure, Minnesota’s official health insurance marketplace, where they can easily find, choose and purchase health insurance. MNsure’s open enrollment period begins November 1, 2023, and will run through January 15, 2024. Open enrollment is the annual opportunity to enroll in health coverage, change plans, and renew coverage.

MNsure estimates that Minnesotans who are eligible for tax credits will save $6,750 in 2024 and spend 5% less on private health plan premiums than they did this year, on average.

These significant savings are thanks to advanced premium tax credits, which act like an instant discount to lower the cost of monthly premiums – but are only available when you enroll in health insurance through MNsure. For example:

via the Centers for Medicare & Medicaid Services (CMS):

In June 2023, 92,614,205 individuals were enrolled in Medicaid and CHIP.

• 85,614,581 individuals were enrolled in Medicaid in June 2023, a decrease of 1,169,095 individuals (1.3%) from May 2023.

• 6,999,624 individuals were enrolled in CHIP in June 2023, a decrease of 32,449 individuals (0.5%) from May 2023.

• As of June 2023, enrollment in Medicaid and CHIP has decreased by 1,304,004 since March 2023, the final month of the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA) and amended by the Consolidated Appropriations Act, 2023.
  • Medicaid enrollment has decreased by 1,175,034 individuals (1.4%).
  • CHIP enrollment has decreased by 128,970 individuals (1.8%).

• Between February 2020 and March 2023, enrollment in Medicaid and CHIP increased by 23,043,140 individuals (32.5%) to 93,918,209
  • Medicaid enrollment increased by 22,709,822 individuals (35.4%).
  • CHIP enrollment increased by 333,318 individuals (4.9%).

Originally posted 8/18/23

Utah's preliminary 2024 individual and small group market rate filings are listed below. They launched a handy new website specifically dedicated to insurance filings, which is nice to see.

Unless there's a change in the final/approved rates, unsubsidized individual market plan premiums are increasing by around 11.4% in 2023, while small group plans will go up 10.5% on average (caveat: I had to estimate the actual enrollment numbers for two of the small group carriers, so the weighted average may be slightly off). Both market hikes are significantly higher rate increases than they were last year.

I should note that both Aetna and Imperial Health appear to be newly entering the Utah individual market next year.

UPDATE 10/04/23: The Utah Insurance Dept. has published approved rates for all individual & small group market carriers with one exception (Molina is still listed as "submitted," but they only have 0.6% of the total market anyway so any dramatic change to their final rates would be a rounding error at most statewide).

Overall most of the filings were accepted as is, although a couple saw significant changes: BridgeSpan had their 6.7% increase nearly doubled to 12.1%, while Regence BCBS was shaved down slightly, from 9.2% to 8.8%.

via the Centers for Medicare & Medicaid Services (CMS):

For the first time, Medicare is able to directly negotiate the prices of prescription drugs due to President Biden’s prescription drug law, the Inflation Reduction Act. Today, Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure issued the following statement on the announcement that the drug companies that manufacture all 10 drugs selected for the Medicare Drug Price Negotiation Program for the first cycle have chosen to participate in the Negotiation Program. The negotiations with participating drug companies for the selected drugs will occur in 2023 and 2024 with the negotiated prices effective beginning in 2026. 

via Maryland Health Connection:

COMPARE 2024 HEALTH PLANS AND PRICES ON MARYLANDHEALTHCONNECTION.GOV

BALTIMORE (Oct. 3, 2023) – Marylanders can now preview 2024 health plans and prices on MarylandHealthConnection.gov, the state’s online health insurance marketplace. Use the “Get an Estimate” tool to compare health plans and savings. Open enrollment to sign up for a 2024 health plan runs from Nov. 1, 2023 through Jan. 15, 2024. Enroll in plans from Aetna, CareFirst, Kaiser Permanente and UnitedHealthcare. Vision and dental plans also are available.

“Maryland Health Connection is committed to keeping rates as low as possible for Marylanders and their families. We offer some of the lowest rates in the nation," said Michele Eberle, executive director of the Maryland Health Benefit Exchange. “Life happens. A health plan can give you a sense of security and stability when parts of your life may feel unpredictable.”

In August, I posted an unweighted average of the preliminary rate filings for Nevada's individual & small group markets; it was unweighted at the time because I was unable to find the actual unredacted rate filing forms on the SERFF database, federal Rate Review website or even Nevada's own insurance filing database site.

Fortunately, now that the approved 2024 filings have been published, the NV DOI has added the Rate Change Justification forms to their database, making it easy to plug in the number of enrollees for every carrier in both markets. It's also important to note that there are two new carriers joining Nevada's individual market: Molina Healthcare and Imperial Insurance Co.

Overall, the weighted average rate increases are 3.8% for unsubsidized individual market plans and 6.4% for small group market enrollees.

via the Centers for Medicare & Medicaid Services (CMS):

The Departments of Health and Human Services, Labor, and the Treasury (the Departments) are seeking public input on how best to ensure coverage and access to over-the-counter (OTC) preventive services, including the benefits of requiring most health insurance plans to cover these services at no cost and without a prescription by a health care provider. This new Request for Information (RFI) solicits comment on access to a range of OTC items recommended by experts for preventive care that can be purchased without a prescription, including contraceptives, tobacco smoking cessation products, folic acid during pregnancy, and breastfeeding supplies.