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CMS rule limiting 3rd-party Medicare Advantage, Part D marketing now in effect

A CMS rule revising Medicare Advantage and Part D marketing and communication regulations went into effect June 28 to increase oversight over third-party marketing organizations. Medicare Advantage and Medicare Part D plan sponsors must comply with the new CMS rule first put forth on May 9.  Six things to know: TPMOs are now defined as “organizations and…

ARPA Subsidy Expiration Could Drive 2023 Premium Rate Changes
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ARPA Subsidy Expiration Could Drive 2023 Premium Rate Changes

The expiration of the American Rescue Plan Act (ARPA) premium subsidies and the return of Medicaid redeterminations will likely result in 2023 premium rate changes for individual and small group health insurance plans, according to an issue brief from the American Academy of Actuaries. As payers begin their premium rate filing process, they must consider projected medical…

Aduhelm price cut, limited coverage leads CMS to lower Medicare premiums in 2023
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Aduhelm price cut, limited coverage leads CMS to lower Medicare premiums in 2023

A hefty price cut and narrow coverage determinations for Biogen’s controversial Aduhelm have led Department of Health and Human Services Secretary Xavier Becerra to order a lower premium rate for the coming year. (Biogen) Medicare Part B beneficiaries’ premiums will be lowered in 2023 to compensate for lower-than-expected spending on Biogen’s Alzheimer’s disease drug Aduhelm,…

KFF: Up to 14M enrollees could lose Medicaid coverage as states restart eligibility checks

KFF: Up to 14M enrollees could lose Medicaid coverage as states restart eligibility checks

Between 5.3 million and 14.2 million enrollees could lose Medicaid coverage next year as the Biden administration is expected to roll back the program’s continuous coverage provision, a new analysis finds.  The analysis, released Tuesday by the Kaiser Family Foundation, explores how much enrollment in Medicaid changed during the pandemic, including the impact of a…

ICHRA vs QSEHRA
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ICHRA vs QSEHRA

If you’re wondering what the difference is between an ICHRA and a QSEHRA, you’re not alone. This is one of the most common questions employers have when looking into what benefits they want to offer to their employees. Both health reimbursement plans, or HRAs, allow employers to provide affordable and personalized benefits to their employees….

Study: Medicare Advantage saves seniors nearly $2K a year compared to fee-for-service

Study: Medicare Advantage saves seniors nearly $2K a year compared to fee-for-service

Seniors save nearly $2,000 on average a year in total healthcare spending in Medicare Advantage (MA) compared to fee-for-service Medicare, a new study finds. The study, published Tuesday, by the advocacy group Better Medicare Alliance finds that seniors spent $1,965 less including premiums and out-of-pocket costs on MA when compared to fee-for-service. “We see particularly…

New Special Enrollment Period (SEP)
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New Special Enrollment Period (SEP)

The new Special Enrollment Period (SEP) for individuals making less than or equal to (≤) 150% of the Federal Poverty Level (FPL) is expected to be implemented in late March 2022. ≤150% FPL SEP Details APTC-eligible consumers with a projected annual income ≤150% FPL will be able to enroll on a monthly basis:  Eligible consumers who are…

MORE TIME TO ENROLL

MORE TIME TO ENROLL

The Colorado Division of Insurance is offering a Disaster Relief Special Enrollment Period (SEP) for uninsured Coloradans who have been affected by either the Marshall Fire or the surge in Omicron COVID-19 infections. This SEP is in effect from January 16 – March 16, 2022 and is available for both on and off marketplace enrollments. Coloradans will…

COBRA users face end to temporary premium payment help
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COBRA users face end to temporary premium payment help

The end of a temporary federal health insurance premium subsidy program could push millions of people into the market for individual and family health coverage Oct. 1. The program, created by the American Rescue Plan Act of 2021 (ARPA), provided billions of dollars in aid to help displaced workers keep their usual employer-sponsored health benefits…