New data from the first three months of 2019 suggest that insurers in the individual market remain profitable, even with average premiums falling for the first time since the ACA was implemented. These data indicate that the individual market appears to be stable so far in 2019, despite the repeal of the individual mandate penalty and the proliferation of loosely-regulated short-term insurance plans.
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Results from mid-2018 suggest that despite significant challenges, the individual market remains stable and insurers are generally profitable. Insurer financial results from 2018 – after the Administration’s decision to cease cost-sharing subsidy payments, but before the repeal of the individual mandate penalty in the tax overhaul goes into effect – showed no sign of a market collapse.
Analysis: Individual Market Insurers Experienced Their Best Financial Year under the ACA in 2017, Though Subsequent Political and Policy Changes Complicate the Outlook for Future Years
Insurers in 2017 had their best financial year selling individual market health insurance since the Affordable Care Act began requiring guaranteed access to coverage for people with pre-existing conditions in 2014, though recent political and policy changes create new challenges for insurers trying to succeed in this market, new Kaiser…
This brief examines recently-released annual financial data from 2017 and finds insurers selling individual market plans had their best financially since 2014, when new ACA insurance market rules took effect that guaranteed access to coverage for people with pre-existing conditions. At the same time, recent political and policy changes, including the repeal of the individual mandate penalty as part of tax reform legislation and proposed regulations to expand loosely-regulated short-term insurance plans, cloud plans’ outlook going forward.
Analysis: Insurer Financial Indicators Show Signs of Stabilizing After Transition to ACA Marketplaces
A new Kaiser Family Foundation analysis of key insurer financial indicators suggests that the individual insurance market showed signs of stabilizing in 2016, although profitability remained below the level of performance prior to the opening of the Affordable Care Act’s insurance marketplaces. The new analysis tracks insurer financial performance in…
This data note looks at trends in insurer financial performance in the individual market, as the Affordable Care Act (ACA) marketplaces were established, finding that the market showed signs of stabilizing in 2016.
This issue brief summarizes major provisions of the Notice of Proposed Rulemaking (NPRM) to modernize and strengthen federal Medicaid managed care regulations, which serves as an informational guide to key proposed new federal expectations and requirements of states and managed care arrangements, and federal oversight interests moving forward.
More than half of all Medicaid beneficiaries now receive their services in risk-based managed care plans, and states’ use of managed care is expanding. States operate their own Medicaid managed care programs within federal rules and requirements. The federal regulations were last updated in 2002 and a new proposed rule is expected in Spring 2015. This brief identifies key issues in the regulation and discusses how CMS might address them.
This report examines nursing facility expenditures to assess relative spending increases in areas such as nursing services, administrative costs, and profits. Using California as a case study, it explores reimbursement by cost category and a standard medical loss ratio (MLR) as potential policy options to improve nursing facility financial accountability and care quality.
The Medical Loss Ratio (MLR) provision of the Affordable Care Act (ACA) saved consumers an estimated $2.1 billion last year, in the form of lower premiums and rebates, according to a new analysis by the Kaiser Family Foundation. Under health reform, insurers must issue consumer rebates if they fail to spend a certain portion of premium income on health care claims and quality improvement expenses, thereby limiting what they may spend on administrative expenses or keep as profits.