The Affordable Care Act, among other things, established a reinsurance program, which is a three-year transitional program designed to stabilize premiums in the individual market. Because insurers can no longer charge a higher premium for individuals with a potentially costly pre-existing condition, this reinsurance program was created to lessen the impact of adverse selection in

The Affordable Care Act, among other things, established a reinsurance program, which is a three-year transitional program designed to stabilize premiums in the individual market. Because insurers can no longer charge a higher premium for individuals with a potentially costly pre-existing condition, this reinsurance program was created to lessen the impact of adverse selection in

As a follow up to our Blog dated 10/21/14 (blog), earlier today, the U.S. Supreme Court agreed to consider a challenge to the premium tax credits (subsidies) that are a key component of the ACA.  King v. Burwell challenges whether the tax credits apply only to consumer marketplaces established by a state or

Recently, we have received requests to re-post prior articles on the 90-day waiting period, the employer mandate final rules (supplemented here, here, here and here), and our pop quiz for ACA consultants.  As we approach our 100th article, some readers apparently find the scroll-down browsing process tedious.  So do we.  Here

The ACA generally requires issuers of non-grandfathered health insurance coverage offered in the group and individual markets to guarantee availability of coverage. The final regulations related to this requirement equate discrimination in marketing practices or benefit designs with a violation of the guaranteed availability requirement. Specifically, 45 CFR § 147.104(e) states that:

(e) Marketing. A

Due to rising health care costs, employers are seeking ways to offset these costs.  One of the many things employers are considering is on-site health clinics.  While on-site health clinics are often viewed as a way to supplement an employer’s current health plan for employees, there are many issues that must be considered when deciding

On January 31, 2014, the Office of Inspector General (“OIG”) for the Department of Health and Human Services released its Work Plan for Fiscal Year 2014. The Work Plan sets forth OIG’s audit and enforcement priorities for the coming year and, as such, is a must read for health care providers.  The success of OIG’s

With January 1, 2014 getting closer every day, and the federal Marketplace still not working, people are faced with big decisions about their health care for 2014.  We want to help.  We thought it would be a good time to explain exactly how the individual penalty works.

How to Calculate the Penalty

It’s really hard

We have little to add to the widespread, mostly accurate descriptions of the dysfunction, to date, of www.healthcare.gov as a health plan purchase portal.  Three weeks in, the biggest observable change has been the addition of new buttons to this welcome screen, allowing visitors to call or click to obtain quick, ballpark price “estimates” for