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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,…

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…

Downstream Impacts of Making American Rescue Plan Act Permanent
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Downstream Impacts of Making American Rescue Plan Act Permanent

Making the American Rescue Plan Act permanent could lower costs on the Affordable Care Act marketplaces and eradicate the Medicaid coverage gap, but it would also cost the federal government up to $333 billion in the policy’s first decade, according to a Commonwealth Fund report. The researchers used the Urban Institute’s Health Insurance Policy Simulation Model in order…

Washington State insurance commissioner slams Texas anti-abortion law
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Washington State insurance commissioner slams Texas anti-abortion law

Amid the controversy caused by Texas passing a new law that bans abortions after about six weeks of pregnancy, Washington State Insurance Commissioner Mike Kriedler has issued a statement denouncing the legislation. In addition to prohibiting abortion after a set period of time, the new Texan law also allows private citizens to sue abortion providers…

Unvaccinated patients have cost health care system $2.3B since June
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Unvaccinated patients have cost health care system $2.3B since June

Nearly three in 10 adults in the United States have not been vaccinated against COVID-19. Although the toll on public health has been well-documented, increased hospitalizations also are also costing taxpayer-funded public insurance programs and workers and businesses who pay health insurance premiums. Although real-time data on the cost of all COVID-19 hospitalizations are not…

Delta Air Lines’ health insurance surcharge: Is it legal, and five other questions you may be asking
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Delta Air Lines’ health insurance surcharge: Is it legal, and five other questions you may be asking

Delta Air Lines Inc. announced Wednesday that it would impose a $200 monthly surcharge on employees who aren’t inoculated against Covid-19, pioneering an alternative to the vaccine mandates issued by other corporations as they seek to limit the spread of the highly contagious delta variant while reopening. Here, Max Nisen — who covers health care…

Survey reveals impact of COVID-19 on Americans’ approaches to health insurance
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Survey reveals impact of COVID-19 on Americans’ approaches to health insurance

COVID-19 has made Americans more anxious about dying, becoming disabled or needing long-term care, according to the results of a recent survey conducted on behalf of the Million Dollar Round Table (MDRT), a global trade association of life insurance and financial services professionals. The survey provides insight from more than 1,050 U.S. residents about how…

Many insurers are no longer waiving cost sharing for COVID-19 treatment
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Many insurers are no longer waiving cost sharing for COVID-19 treatment

Last year, during the height of the pandemic, many insurers voluntarily waived patient cost sharing for COVID-19 treatment. Cost sharing is what a patient owes out of their own pocket, either through a deductible, copay or coinsurance. Insurers waived those costs while experiencing record profits due to many people across the country putting off care…