Health Insurance News – October 28, 2021 Edition

Open enrollment for the individual market well-being plans starts Sunday

Starting this Sunday, November 1st, people in every state can shop for individual-market health insurance coverage for 2021. About 13 million people who buy their own health insurance (rather than getting it through an employer or the federal government via programs such as Medicare and Medicaid) are eligible for this window. The upcoming open enrollment period will allow thousands of uninsured people to secure health insurance for 2021.

Even if you are happy with your current plan, you should still actively shop and compare the available plan options for 2021. According to CMS, 30% of HealthCare.gov enrolled individuals who receive premium subsidies will have access to at least one plan that has a monthly premium of less than $10 for 2021. Nearly three quarters of these enrollees can get a plan under $75/month. Most people will have access to high-deductible health plans that qualify for HSAs, which are necessary to be able to contribute to an well-being financial savings account. More than a third of counties in HealthCare.gov state could offer at least one Gold plan that is priced below the benchmark Silver plan. This means people with subsidy eligibility can get Gold coverage for a very low price.

But it’s not just about premiums. You should pay close attention to the specifics of protection and the provider community. Questions? You can get help from a local dealer or navigator. You’ll still get the same price, but you will have someone to help you sort out the details.

This guide to 2021 open enrollment is an overview of all the information you need to know if you are shopping for your own medical insurance in the fall. We also have an information on Medicare’s open registration period, which started earlier this month and will continue for another six weeks.

Now you can buy the 2021 health plan almost anywhere

Nine state-run exchanges already had window buying for health plans in 2021. This week, Connecticut and Washington have also joined the exchanges, as has HealthCare.gov which is used in 36 states.

Although we still have a few days before people can start actively shopping for their 2021 coverage, residents of nearly every state in the country can use anonymous shopping tools to see what is available for next year and how much it will cost.

Look at healthcare poll measures

In the first half of this year, two of the most watched poll measures for 2020 were on major ballots: Missouri and Oklahoma voters accepted Medicaid expansion initiatives. As a result, expanded protection eligibility may be implemented in both states by mid-2021.

There are several vital health care measures on the ballot for next week’s general election.

  • Oklahoma: Fund Medicaid expansion. State Question 814, if approved by voters, would alter the way Oklahoma’s settlement money is allocated in order to provide more funding for Medicaid. Presently, 75 percent of the tobacco settlement money goes to the Oklahoma Tobacco Settlement Endowment Belief, which provides grants for programs aimed at stopping cancers, coronary heart disease, tobacco cessation programmes, etc. The state legislature shares 25 percent with the attorney general’s office. State Query 814 flips these percentages so that the legislature receives 75 p.c (less the amount that is sent to the legal expert basic’s office, which could stay unchanged). The additional cash would be used to fund Medicaid. Oklahoma is facing a pressing issue, since voters have already approved a ballot initiative that calls for Medicaid expansion, and legislators are required to decide the funding for Oklahoma’s share of the cost. The federal government pays 90% of the cost of Medicaid expansion, while the state pays 10%.
  • Colorado: Medical and household leave paid. Proposition 118, if approved by the voters, would provide up to 12 weeks of paid medical or household leave (16 weeks in case of pregnancy or childbirth issues). This system would be funded through a payroll tax exemption between employees and employers. The maximum profit could be as high as $1,100/week.
  • California: State requirements for dialysis centers. Proposition 23 requires that dialysis centers have a doctor or nurse practitioner on site during dialysis treatments if it is approved by the voters. The measure could also prohibit dialysis centers from refusing service to individuals based on their medical insurance, and would require clinics get state approval before they can close the facility or reduce services. Proposition 23 has the support of the Service Staff Worldwide Union – United Healthcare Employees West, which was the group that sponsored the measure that voters rejected last year. SEIU-UHW West also played a major role in another failed Arizona poll measure: In July, we told you how supporters had collected enough signatures to put the Arizona Hospital Employee Minimum Wage and Insurance Coverage Rules Initiative on the ballot. The measure was rejected later by the Arizona Supreme Court and a Maricopa County judge, preventing it from appearing on the poll next week.

Georgia’s shock bill transparency legislation comes into effect Nov. 1,

Georgia’s House Invoice 789, which was passed with almost unanimous support in the state legislature in June before being signed into law in July, will take effect this Sunday. The law is intended to help customers avoid shock balance billing. However, it only applies to health plans that are regulated by the State, and does not include self-insured groups plans. These plans are for the majority of people with employer-sponsored health insurance and are regulated instead by the federal government.

According to HB789 health plans are required to provide information about the specialty teams of their in-network hospital. Anesthesiologists are included in this category, as well as radiologists, pathologists and emergency medicine physicians. These four specialties are most likely to be outside of the network, leaving patients at risk for shock billing. The insurer will need to indicate a green checkmark next to each specialty group that is also in-network in that hospital. A purple X should be displayed if that specialty group is not in-network. A green N/A can be used if a hospital does not provide the specialty service. If there are fewer than four checkmarks on a hospital, the insurer must give clear details about the specialty groups or teams that aren’t in-network.

What is at stake in California v. Texas

The Supreme Court will hear oral arguments in the case that could overturn the ACA – California v. Texas (formerly Texas v. Azar) when it was before the lower courts – on November 10. Amy Coney Barrett has confirmed the Court’s conservative majority. There is a lot of excitement about how the Court will rule in this case someday next year. We stated last week that the consequences of overturning the ACA could be disastrous, with thousands of People losing their health insurance coverage as a result.

Several states have taken action on the state level to at least protect some of the ACA’s consumer protections if the legislation is overturned. However, the lack of federal funding for the ACA (for Medicaid enlargement or premium subsidies) may be a significant hurdle.

Amy Lotven reported in this week’s issue that the contracts insurers signed with HHS for the provision of plans through HealthCare.gov include an “exit” clause that could allow the insurers to terminate their contracts with federal authorities if ACA premium tax credits are terminated. Although there are no laws in place that could end the premium tax credit at this time, it would be ended if the Supreme Court overturned the ACA.

Although the Supreme Court will hear oral arguments in the case in November, it could be several months before the Court issues an opinion. Decisions in important cases are usually available in June. Although it is possible that the Court will overturn the ACA at some point next year, it is also feasible that Congress could move legislation to reinforce the ACA’s consumer protections, and ensure that there’s a smooth transition, even if the current legislation is overturned.

For now, it’s important to remember that people must enroll in coverage during open enrollment, just as they have done for the previous seven years. Protection will go into effect on January 1, 2021. This is a long time before we know the Supreme Court’s ruling in California v. Texas.


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