All Articles In 'Tag Archives: 'Health Plans''
Health Insurance Administrative Expenses: Details on Administrative Expenses of Health Plans in Large Group, Small Group, and Individual Markets
Health insurance plans are required to report their administrative expenses. For health plans in the for the large group, small group, and individual insured markets, an new report from Milliman details insurers’ administrative expenses in five [...]
Health Plans and Quality Improvement Reporting Under the Affordable Care Act: Recommendations for Implementing Reporting of Quality Improvement Strategies
The Affordable Care Act (ACA) requires the Centers for Medicare and Medicaid Services (CMS) issue employer group health plan quality improvement reporting requirements. Reports shall cover specified quality improvement activities regarding plan or coverage benefit and [...]
Health Insurer Fee Impact on Medicaid: Financial Impact of ACA Health Insurer Fee on State Medicaid Programs and Medicaid Health Plans
A new federally mandated tax on health insurers will increase costs for state Medicaid programs and Medicaid health plans. In an excellent new report, PPACA Health Insurer Fee Estimated Impact on State Medicaid Programs and Medicaid Health [...]
Medicare Advantage Risk Adjustment: GAO Recommends CMS Risk Score Adjustments for Diagnostic Coding
Through the years, the Centers for Medicare and Medicaid Services (CMS) has changed its payment adjustment method for Medicare Advantage (MA) plans. These adjustments are made based on a calculated risk score per beneficiary, which should be consistent [...]
Guaranteed Issue and Community Rating Reforms: Actuarial Analysis of Impact on Individual Health Insurance Markets
In previous research, Milliman, one of the nation’s top actuarial firms, provided an overview of the impact made by guaranteed issue and community rating reforms on the health insurance markets within eight states in the 1990s. Retained [...]
Individual Mandate: Projecting the Strength of the Individual Mandate on Health Insurance Participation
The Affordable Care Act (ACA) requires that most Americans have health insurance that meets minimum federal requirements. Under the controversial mandate, starting in 2014, most individuals under 65 must purchase minimum essential health insurance coverage or [...]
Prevention: Variation in Cost of Diabetes, Cancer, and Cholesterol Screenings
More than 75 percent of total health care costs cover preventable chronic conditions like diabetes, heart disease, and cancer. The Affordable Care Act (ACA) mandates that self-insured employers and health plans provide common, evidence-based wellness screenings [...]
Health Opportunity Accounts: Results of Medicaid Health Opportunity Accounts Demonstration Program
Following a five-year demonstration, a new report examines the Health Opportunity Accounts Demonstration Program created by the Deficit Reduction Act (DRA). The law allowed up to 10 states to test the use of Health Opportunity Accounts as an [...]
Employer Sponsored Health Insurance: Changes in Health Premiums and Employee Contributions for Health Insurance
The Agency for Healthcare Research and Quality (AHRQ) has released interesting new data on increases in premiums and employee contributions for employer-sponsored health insurance coverage (ESI) from 2001 to 2009. Types of Employer-Sponsored Health Insurance Coverage: [...]
Medicare and Medicaid Compliance: OIG Advice for Operating an Effective Compliance Program
Comprehensive compliance programs are essential for all hospitals, health systems, physician practices, Medicare Advantage plans, Medicaid health plans, Medicare prescription drug plans, drug manufacturers, medical device makers, long-term care providers, and others doing business with Medicare, Medicaid, or [...]
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