Biden-Harris Administration Announces Medicare Advantage and Medicare Part D Prescription Drug Proposals that Aim to Improve Care and Access for Enrollees
Today, the Centers for Medicare & Medicaid Services (CMS) is proposing actions in the Medicare Advantage (MA) and Medicare Part D prescription drug programs to continue to strengthen protections and access to care for people with Medicare. The Contract Year (CY) 2026 MA and Part D proposed rule aims to hold MA and Part D plans more accountable for delivering high-quality coverage so that people with Medicare are connected to the care they need when they need it.
Covered California announced the first-year results of its first-in-the nation health plan accountability program, the Quality Transformation Initiative(QTI), today at its board meeting.
The QTI — aimed at improving health care outcomes and reducing disparities for members — was created with input from consumer advocates, health care providers and health insurance companies. It was developed in collaboration with the Department of Health Care Services and CalPERS.
The QTI establishes direct and substantial financial incentives (up to 1 percent of premium in the first year, rising to 4 percent of premium in future years) for all Covered California health insurance companies by requiring payments for failing to meet specified benchmarks for a focused, meaningful set of health-outcome measures. These equity-centered outcome measures include blood pressure and diabetes control, colorectal cancer screening and childhood immunizations.
Now is a great time to sign up for health and dental insurance
Open enrollment now through Jan. 15; 2024 election results do not affect 2025 coverage
Open enrollment on Washington Healthplanfinder™, the state’s marketplace for private health and dental insurance, is going strong and coverage for 2025 is unchanged by the results of the 2024 election. Through Washington Healthplanfinder, operated by Washington Health Benefit Exchange (Exchange), Washingtonians can choose from a variety of plans available in all regions across the state and access more savings than ever before.
Yep, my wife & I screwed up royally. Yes, I know: I'm "The ACA Guy" and yes, it's incredibly embarrassing to tell this story, but I'm doing so in the hopes of helping others avoid making the same mistake.
It's been several years since we enrolled in an ACA policy ourselves via HealthCare.Gov, since we were enrolled in my wife's student plan up until recently (she returned to college to get her master's degree). The last few times we were able to enroll or renew our policies without any issues, so we assumed it wouldn't be an issue this time.
However, there seem to have been a few changes to some of the questions during the application process, and one of them threw us for a loop.
In the household income section of the application process, Healthcare.Gov asks both how much you expect to earn this month specifically (November 2024) as well as how much you expect to earn for all of 2025.
It was the first of these questions which is what caused the problem for us.
You see, both my wife and I are self-employed, which means we have highly variable incomes--we may earn $10,000 one month but not earn anything the next.
The Maine Department of Health and Human Services (DHHS) Office of the Health Insurance Marketplace (OHIM) will release biweekly updates on plan selections through CoverME.gov, Maine’s Health Insurance Marketplace.
Plan selections provide a snapshot of activity by new and returning consumers who have selected a plan for 2025. “Plan selections” become “enrollments” once consumers have paid their first monthly premium to begin insurance. These numbers are subject to change as consumers may modify or cancel plans after their initial selection.
The deadline to select a plan for coverage beginning January 1, 2025 is December 15, 2024. Consumers who select a plan between December 16, 2024 and January 15, 2025 will have coverage beginning February 1, 2025.
Over 496,000 New Consumers Selected Affordable Health Coverage in ACA Marketplace
The Centers for Medicare & Medicaid Services (CMS) is committed to creating a robust Marketplace Open Enrollment process for consumers so they can effortlessly purchase high-quality, affordable health care coverage. CMS reports that 496,000 consumers who do not currently have health care coverage through the individual-market Marketplace have signed up for plan year 2025 coverage.
IMPORTANT: See caveats below regarding the impact of Medicaid Unwinding & other enrollment changes over time on these estimates.
12/12/24: Note: ACA Medicaid Expansion data has been updated by 3 months for most states, from March 2024 to June 2024.
(sigh) Annnnd here we go again. With another GOP trifecta and Trump's Project 2025 promising draconian cuts to federal spending, there's a very good chance that the Affordable Care Act is, once again, on the chopping block.
I have no idea what's going to happen to either it, Medicaid, Medicare, the Children's Health Insurance Program (CHIP), the VA or the Indian Health Service, but whatever it is probably isn't gonna be pretty.
With that in mind, I figured it would be helpful to take stock of just how many Americans are actually receiving healthcare coverage through the ACA...and while I've crunched this number several times before (spoiler: the grand total is a little shy of 45 million people nationally), I'm taking it several steps further this time and breaking it out not only by state, but by Congressional District (CD).
On November 8, 2024, the Centers for Medicare & Medicaid Services (CMS) released the 2025 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2025 Medicare Part D income-related monthly adjustment amounts.
Medicare Part B Premium and Deductible
Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.
DC Residents Can Get Covered at DCHealthLink.com from November 1, 2024 – January 31, 2025
(Washington, DC) – Mayor Muriel Bowser announced that the 2025 Open Enrollment period will start tomorrow, Friday, November 1, and is encouraging DC residents to sign up for high-quality, affordable health insurance at DCHealthLink.com, the District’s online state-based health insurance marketplace. Open enrollment for individuals and families begins on November 1, 2024 and continues through January 31, 2025.
“Part of making sure that everyone in our community is getting the right care at the right time means getting more residents insured,” said Mayor Bowser. “We are making high-quality health care more affordable for more residents and using insurance to address disparities in health outcomes. We want Washingtonians to check out their options and get covered.
To start coverage on January 1, 2025, Pennsylvanians must enroll by December 15, 2024
Harrisburg, PA – With the Shapiro Administration committed to cutting costs and delivering results for Pennsylvanians, the Pennsylvania Insurance Department (PID), Department of Human Services (DHS), and Pennie joined together today to remind Pennsylvanians that Pennie’s Open Enrollment period is underway, offering affordable health insurance options for 2025.
“This Open Enrollment period is the best time to explore available options and shop around to find a plan — even if you already have insurance. Quality, comprehensive health care coverage has never been more affordable, or more within reach for Pennsylvanians,” said Pennsylvania Insurance Commissioner Michael Humphreys. ”PID’s focus on increasing Marketplace competition has delivered more choices and greater affordability for consumers across the Commonwealth.”
Trump expected to select Robert F. Kennedy Jr. to lead HHS
President-elect Donald Trump is expected to nominate former presidential candidate and anti-vaccine activist Robert F. Kennedy Jr. to lead the Department of Health and Human Services, according to a person with direct knowledge of the selection.
The expected pick, which will roil many public health experts, comes after Trump promised to let Kennedy “go wild” with health and food policy in his administration after Kennedy dropped his own presidential bid to endorse the now-president-elect. It’s also a sign of the opening Trump sees after he scored a decisive electoral victory and Republicans won a comfortable majority in the Senate.
Trump could still select someone else for the post. The Trump transition couldn’t immediately be reached for comment.
“He’s going to help make America healthy again. … He wants to do some things, and we’re going to let him get to it,” Trump said in his victory speech. “Go have a good time, Bobby.”
I made a commitment to keep this site up and running through next spring, and I intend on keeping this commitment. Beyond that, I have no idea what my plans for the site are.
After yesterday's atrocity, however...I'm honestly dreading the thought of what most of my charts, graphs, spreadsheets and blog entries are going to look like.
You see those impressive-looking odometer-style numbers at the top of the home page? Yeah, forget about those. They're meaningless now.
A lot of people will still sign up, but I'm guessing many who were planning on doing so once they were certain the ACA would still be around next year are now going to take a pass. And that's simply the beginning.
Beyond that...it's 4:30am. I'm exhausted, my stomach hurts and my hands are shaking.
God help us all.
I've spent the past week trying to decide how to approach the elephant in the room this time around.
Enrollment Specialists available at events to help consumers in English and Spanish
HARTFORD, Conn. (Nov. 1, 2024) — Access Health CT (AHCT) today announced it will hold 10 enrollment fairs in November to help Connecticut residents shop, compare, and enroll in health or dental coverage. They can also renew their coverage. Enrollment fairs are one-day events for customers to get free, in-person help from experts. The fairs will take place in Bridgeport, Bristol, Fairfield, Hartford, Middletown, New Haven, Norwalk, Torrington, Waterbury and Willimantic.
Open Enrollment begins today. When you enroll affects when your coverage starts. If customers enroll on or before Dec. 15, 2024, coverage will start Jan. 1, 2025. If they enroll between Dec. 16, 2024, and Jan. 15, 2025, coverage will start Feb. 1, 2025.
I want to acknowledge the questions about the future of health policy since Tuesday’s election.
We’ve successfully navigated periods of uncertainty like this several times in the past, including eight years ago, and we didn’t do it alone. You, our customers, stakeholders, and partners, make it possible to move forward together.
There are several things that we know.
The Affordable Care Act is still the law of the land.
Senate Bill 11-200, the state law that created Connect for Health Colorado, is still the law of the state. There are several other important state laws that ensure quality, affordable, and comprehensive health coverage for Coloradans.
There are significant savings available to customers who enroll through the Marketplace for Plan Year 2025.
Sorry about the headline, but it's kind of difficult to focus on stuff which seems pretty mundane at the moment.
Still, it is part of my job to analyze the annual weighted average premium rate changes for ACA individual & small group policies to the best of my ability, so I'm doing that.
The final/approved rates for 2025 mostly come from the federal rate review database, although in some states they come directly from their insurance department website or the SERFF database.
Oddly, the federal rate review database still only has partial data for Oklahoma and Tennessee, and none at all for Wyoming, even though we're nearly a week open enrollment, so I can't plug those in yet. Huh.
You'll have to forgive me my poor metaphor below, but it's the best I can think of at the moment. I've been awake for 29 hours straight now, as I woke up at 5am yesterday for a 15-hour shift as a poll worker in Pontiac, Michigan, and, like many of you I'm sure, I was unable to sleep at all last night. I just got off a devastating phone call with my son who's a freshman in college who doesn't understand why what just happened...happened.
There's going to be a mountain of digital & physical ink spilled and a cacophony of talking heads on the Sunday morning shows yapping about What Went Wrong, yadda yadda yadda. Most of it will be bullshit. Some of it will be accurate.
Since writing about healthcare is my thing, and writing about the ACA specifically is very much in my wheelhouse, I'm going to put my take on this into healthcare risk pool terms. Besides, assuming the GOP also keeps control of the House, the ACA is likely gone (and even if they don't, it's about to be radically gutted via regulatory actions anyway), so I might as well.
