CMS Approves Added Benefits to Essential Health Benefits (EHB) Benchmark Plans in North Dakota and Virginia
September 6: CMS approved added benefits to the Essential Health Benefits (EHB) benchmark plans for North Dakota and Virginia for the 2025 plan year. The Affordable Care Act requires non-grandfathered health plans in the individual and small group markets to cover essential health benefits (EHB), which include items and services in ten benefit categories. For plan year 2020 and after, the Final 2019 HHS Notice of Benefits and Payment Parameters provides states with greater flexibility by establishing new standards for states to update their EHB-benchmark plans, and for tailoring them to fit the health care needs of their states.
Here's the best summaries I could find of the additional benefits for each state:
FDA Takes Action on Updated mRNA COVID-19 Vaccines to Better Protect Against Currently Circulating Variants
Today, the U.S. Food and Drug Administration took action approving and authorizing for emergency use updated COVID-19 vaccines formulated to more closely target currently circulating variants and to provide better protection against serious consequences of COVID-19, including hospitalization and death. Today’s actions relate to updated mRNA vaccines for 2023-2024 manufactured by ModernaTX Inc. and Pfizer Inc. Consistent with the totality of the evidence and input from the FDA’s expert advisors, these vaccines have been updated to include a monovalent (single) component that corresponds to the Omicron variant XBB.1.5.
Pennie was created with the promise of providing quality and accessible health coverage to all Pennsylvanians. Since its inception, Pennie has implemented several initiatives to expand access to health coverage through the marketplace, including through record levels of financial help and reducing language access barriers. The data included in this report, as explained in detail throughout, support several key takeaways that establishes not only the current status of health equity in Pennsylvania, but also the additional steps necessary to reduce health inequities.
Last Tuesday I noted that a package of bills designed to codify various ACA protections into state law here in Michigan (most of which are low-hanging fruit of my own healthcare wish list which I posted back in February) had managed to make it halfway through the legislative process: Five of them have passed the Michigan House, but not the Senate; the other three have passed the Michigan Senate...but not the House. I applauded the state legislature for pushing these bills halfway through and encouraged them to get the other half of the job done.
CONNECTICUT INSURANCE COMMISSIONER ANNOUNCES 2024 HEALTH INSURANCE RATES SAVING ACA HEALTH INSURANCE PLAN MEMBERS $96.2 MILLION AND HOLDING INSURER PROFITS TO 0.75%
(Hartford, CT) – In a significant move to protect Connecticut consumers against unsupported health insurance cost increases, Connecticut Insurance Commissioner Andrew N. Mais announced today that the Connecticut Insurance Department (CID) continues to protect consumers by reducing health insurers’ 2024 requested rates, despite ongoing increases in underlying health care costs. These 2024 rates are for individual and small group plans offered on and off the state exchange Access Health CT. The Connecticut Insurance Department does not regulate self-funded plans which fall under the authority of the U.S. Department of Labor.
Over at KFF (previously the Kaiser Family Foundation), researchers/analysts Jared Ortaliza, Krutika Amin & Cynthia Cox have put together a new analysis of the overall individual (aka non-group) U.S. health insurance market as of early 2023. While ACA exchange-based enrollment is publicly available (for both subsidized & unsubsidized enrollees) and is the primary focus of this website, off-exchange enrollment is always somewhat fuzzier for several reasons:
New CMS data, quietly released in late August, show about 178,000 consumers chose a qualified health plan (QHP) through a state or federal exchanges after losing Medicaid and CHIP coverage in the first two months of the Medicaid unwinding. Those sign-ups through the end of May are more than three times the 54,000 enrollments that CMS reported in July, which reflected only the April numbers.
A few weeks ago, I noted that Virginia's average 2023 unsubsidized ACA individual market premiums dropped by nearly 13% thanks to the newly-implemented state-based reinsurance program...but that they were at risk of skyrocketing by as much as 25% in 2024 due to that same reinsurance program being at risk of not continuing for a second year because of a budget standoff:
During 2021, the Virginia General Assembly passed HB 2332, the Commonwealth Health Reinsurance Program, which was signed into law on March 31, 2021 as Chapter 480, of the 2021 Virginia Acts of Assembly. This bill requires the State Corporation Commission to submit a waiver request for federal approval to establish a reinsurance program beginning January 1, 2023.
Massachusetts, which is arguably the original birthplace of the ACA depending on your point of view (the general "3-legged stool" structure originated here, but the ACA itself also has a lot of other provisions which are quite different), has 10 different carriers participating in the individual market.
One thing which sets Massachusetts (along with Vermont) apart from every other state is that their Individual and Small Group risk pools are merged for premium setting purposes.
Normally you would think this would make my job easier, since I only have to run one set of analysis instead of two...but until recently, it was surprisingly difficult to get ahold of exact enrollment data for each carrier on the merged Massachusetts market (and even more difficult to break out how many are enrolled in each market since they're merged...not that that's relevant to the actual rate changes).
Model aims to improve the overall health of a state population by ensuring providers are delivering efficient, high-quality, and coordinated care to patients
Today, the Centers for Medicare & Medicaid Services (CMS) unveiled a transformative step to test a state’s ability to improve the overall health care management of its state population. The States Advancing All-Payer Health Equity Approaches and Development Model (“States Advancing AHEAD” or “AHEAD Model”) aims to better address chronic disease, behavioral health, and other medical conditions. Under the AHEAD Model, participating states will be better equipped to promote health equity, increase access to primary care services, set health care expenditures on a more sustainable trajectory, and lower health care costs for patients.
