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  • What the Actuarial Values in the Affordable Care Act Mean

    Issue Brief

    The Patient Protection and Affordable Care Act (PPACA) establishes four levels of coverage based on the concept of "actuarial value," which represents the share of health care expenses the plan covers for a typical group of enrollees. As plans increase in actuarial value – bronze, silver, gold, and platinum – they would cover a greater share of enrollees' medical expenses overall, though the details could vary across plans. The levels of coverage provided for in…

  • The Budget Trigger and Health Reform

    Perspective

    No doubt it will take some time to sort out how elements of the debt deal (formally "The Budget Control Act of 2011") will all work. Delving into the details of how it affects subsidies in the Affordable Care Act (ACA) to make insurance more affordable helps to illustrate how complex this business can be. Let's start with a short primer on the ACA subsidies. Starting in 2014 people buying insurance on their own in…

  • Questions About Essential Health Benefits

    Perspective

    The Institute of Medicine (IOM) recently issued its long-awaited report on defining the essential health benefits under the Affordable Care Act (ACA). As expected, the committee preparing the IOM report did not recommend which specific services should be covered, but rather discussed what the process should be for defining the essential benefits, which all insurers selling coverage to individuals and small businesses will have to provide beginning in 2014. Somewhat unexpected was their recommendation to set a…

  • Policy Changes Bring Renewed Focus on High-Deductible Health Plans 

    Issue Brief

    Policy changes, anticipated increases in premium costs for enrollees, and new standards for health savings accounts may encourage consumers to seek out plans with lower premiums but higher deductibles. This issue brief explores the features of bronze and catastrophic plans, coverage and costs, and the complicated choices consumers face.

  • Private Insurance Benefits and Cost-Sharing Under the ACA

    Perspective

    The Department of Health and Human Services (HHS) recently released guidance on the two key components that determine the level of protection that private insurance plans will provide to consumers under health reform. The first involves the services that insurance plans must cover, and the second involves how much patients must pay out-of-pocket for those services. The Affordable Care Act (ACA) establishes new rules for what insurers must provide for both components starting in 2014.…

  • Pending Changes to Marketplace Plans Could Increase Cost Sharing for Consumers

    Policy Watch

    This brief looks at changes to Marketplace plans recently finalized by the Centers for Medicare and Medicaid Services (CMS) that may incentivize insurers to make their plans less generous. With less generous plans, consumers could face higher out-of-pocket costs, though those who don't qualify for premium tax credits could see lower premiums.

  • Implementing New Private Health Insurance Market Rules

    Issue Brief

    With the Jan. 1, 2014 effective date for implementing major changes in the private insurance market under the Affordable Care Act (ACA) approaching, this brief looks at three proposed federal regulations released in late November 2012 that detail how the ACA’s rules will operate in the following areas: private insurance market reforms, essential health benefits and actuarial value, and wellness programs offered or required by employers under group health plans. These regulations deal with aspects…