Transparency and Complexity August 13, 2012 Perspective This fall a new rule takes effect requiring all private health plans to offer a uniform, simple to read, summary of benefits and coverage (SBC). The SBC will provide consumers with standardized information about how plans cover essential health benefits and what coverage limits and cost sharing applies. The SBC…
Private Insurance Benefits and Cost-Sharing Under the ACA February 28, 2012 Perspective The Department of Health and Human Services (HHS) recently released guidance on the two key components that determine the level of protection that private insurance plans will provide to consumers under health reform. The first involves the services that insurance plans must cover, and the second involves how much patients…
Insurance Coverage of Contraceptives February 21, 2012 Perspective In this post, we answer some of the key questions about the new contraceptive coverage policy generally, and more specifically, how it will be applied to religious organizations.
Essential Health Benefits: Balancing Affordability and Adequacy February 3, 2012 Event Under the Patient Protection and Affordable Care Act (PPACA), insurance plans offered through state insurance exchanges as well as non-grandfathered plans offered in the individual and small group markets – will be required to cover a set of health benefits and services called the “essential health benefits” package. Guidance issued…
Medicaid Enrollment and Expenditures by Federal Core Requirements and State Options January 1, 2012 Issue Brief To receive federal Medicaid matching funds, states that participate in Medicaid must meet federal requirements, which include covering specified “federal core” enrollee groups and mandatory health benefits. States also may choose to cover additional “state expansion” enrollees and optional benefits with federal Medicaid matching funds. The federal core eligibility standards…
Restructuring Medicare’s Benefit Design: Implications for Beneficiaries and Spending October 31, 2011 Report Several deficit-reduction plans have proposed combining Medicare’s separate deductibles for hospital and physician services, standardizing cost sharing across types of benefits, and establishing a new limit on annual out-of-pocket costs for beneficiaries. A new Kaiser Family Foundation study examines the potential implications of proposals to revamp Medicare’s cost-sharing requirements as…
Questions About Essential Health Benefits October 18, 2011 Perspective The Institute of Medicine (IOM) recently issued its long-awaited report on defining the essential health benefits under the Affordable Care Act (ACA). As expected, the committee preparing the IOM report did not recommend which specific services should be covered, but rather discussed what the process should be for defining the essential benefits,…
Uniform Coverage Summaries for Consumers October 1, 2011 Issue Brief This brief explains the proposed federal rule that requires private health plans to provide a short, easy-to-read uniform summary of benefits and coverage to all health insurance applicants and enrollees. The rule, which implements a provision in the Affordable Care Act (ACA), is intended to make it simpler for consumers…
Medicaid’s Long-Term Care Users: Spending Patterns Across Institutional and Community-based Settings October 1, 2011 Issue Brief The nation’s primary payer for long-term services and supports, Medicaid finances 43 percent of all spending on long-term care services and covers a range of services and supports, including those needed by people to live independently in the community, as well as services provided in institutions. This report provides an…
The Role of Clinical and Cost Information in Medicaid Pharmacy Benefit Decisions: Experience in Seven States September 1, 2011 Issue Brief This policy brief provides perspective on the potential for using comparative effectiveness research in Medicaid pharmacy programs by looking at seven states to determine how they currently evaluate relative clinical and cost information about prescription drugs when making coverage decisions for their Medicaid pharmacy benefits. The brief was prepared by…
