Insurance Coverage of Contraceptives
In this post, we answer some of the key questions about the new contraceptive coverage policy generally, and more specifically, how it will be applied to religious organizations.
View the Latest: Benefits
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Essential Health Benefits: Balancing Affordability and Adequacy
Event Date:EventUnder the Patient Protection and Affordable Care Act (PPACA), insurance plans offered through state insurance exchanges as well as non-grandfathered plans offered in the individual and small group markets - will be required to cover a set of health benefits and services called the "essential health benefits" package.
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Medicaid Enrollment and Expenditures by Federal Core Requirements and State Options
Issue BriefTo receive federal Medicaid matching funds, states that participate in Medicaid must meet federal requirements, which include covering specified “federal core” enrollee groups and mandatory health benefits. States also may choose to cover additional “state expansion” enrollees and optional benefits with federal Medicaid matching funds.
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Restructuring Medicare’s Benefit Design: Implications for Beneficiaries and Spending
ReportSeveral deficit-reduction plans have proposed combining Medicare's separate deductibles for hospital and physician services, standardizing cost sharing across types of benefits, and establishing a new limit on annual out-of-pocket costs for beneficiaries.
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Questions About Essential Health Benefits
PerspectiveThe Institute of Medicine (IOM) recently issued its long-awaited report on defining the essential health benefits under the Affordable Care Act (ACA).
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Medicaid’s Long-Term Care Users: Spending Patterns Across Institutional and Community-based Settings
Issue BriefThe nation's primary payer for long-term services and supports, Medicaid finances 43 percent of all spending on long-term care services and covers a range of services and supports, including those needed by people to live independently in the community, as well as services provided in institutions.
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Uniform Coverage Summaries for Consumers
Issue BriefThis brief explains the proposed federal rule that requires private health plans to provide a short, easy-to-read uniform summary of benefits and coverage to all health insurance applicants and enrollees.
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The Role of Clinical and Cost Information in Medicaid Pharmacy Benefit Decisions: Experience in Seven States
Issue BriefThis policy brief provides perspective on the potential for using comparative effectiveness research in Medicaid pharmacy programs by looking at seven states to determine how they currently evaluate relative clinical and cost information about prescription drugs when making coverage decisions for their Medicaid pharmacy benefits.
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Medicaid Payment for Outpatient Prescription Drugs
Fact SheetThis fact sheet summarizes Medicaid’s role as the major source of outpatient pharmacy services for low-income Americans. Medicaid spent $25.4 billion on prescription drugs in fiscal year 2009, and outpatient prescription drug coverage is an optional benefit that all state Medicaid programs currently provide. Fact Sheet (.
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Managing Medicaid Pharmacy Benefits: Current Issues and Options
ReportThis report examines reimbursement, benefit management and cost sharing issues in Medicaid pharmacy programs.