Most people who enroll in an exchange/Marketplace health plan are eligible for an advance premium tax credit (APTC). But it’s important to understand how this is reconciled with the IRS after the year is over.
Screening Colonoscopy Incorrectly Billed as Diagnostic
As long as you use an in-network facility, all costs associated with a screening colonoscopy should be paid by the health plan, including the bowel preparation drink, the facility fee, the doctor’s fee, and the anesthesiologist’s fee.
What is an Expanded Bronze Plan?
there is also an option to offer “expanded” bronze plans that can have higher AV than regular bronze plans. In order to be considered expanded bronze, a plan must
What is Silver Loading in the Connect for Health Colorado ACA Exchange?
On exchange with Silver Loading (no Cost Sharing Reduction) vs Off Exchange
Fixing the ACA’s Medicare Glitch
This article was co-written with Andrew Sprung, who writes about health care reform and health policy at xpostfactoid. Andrew has closely followed all aspects of ACA implementation over the years, and his website provides a wealth of information about health care reform. His work has also been published at healthinsurance.org and Health Affairs. For most… Read more about Fixing the ACA’s Medicare Glitch
What if Republicans had succeeded in repeal of the Affordable Care Act?
By Andrew Sprung, David Anderson and Louise Norris On November 10, the Trump administration will ask the Supreme Court in oral argument to declare the Affordable Care Act unconstitutional – and nullify the law in the midst of a pandemic, uninsuring an estimated 23 million people. As Republicans rushed to confirm the nomination of Amy Coney Barrett… Read more about What if Republicans had succeeded in repeal of the Affordable Care Act?
States seeking to reduce their uninsured populations must beware a Catch-22
By David M. Anderson, Charles Gaba, Louise Norris and Andrew Sprung State policymakers have been prolific and creative in putting forward measures to strengthen their ACA marketplaces. Measures enacted since 2017 or in progress now include reinsurance programs, which reduced base premiums by an average of 20% in their first year in the first seven… Read more about States seeking to reduce their uninsured populations must beware a Catch-22
Claiming the ACA tax credit after paying full price for your health insurance
Most people know that there are premium tax credits (often referred to as premium subsidies) available for people who buy their health insurance through Connect for Health Colorado. But claiming the ACA tax credit as an advanced subsidy requires you to estimate your income for the coming year and supplying supporting documentation to verify that… Read more about Claiming the ACA tax credit after paying full price for your health insurance
Treating Employees Differently: Employer Contribution Requirements
Employers offering small business group health insurance benefits have flexibility treating employees differently as long as the contribution policy complies with the insurance company’s employer contribution requirements and basic non-discrimination laws (HIPAA and Section 125). Employers can contribute a flat dollar amount, or they can require employees to pay a set percentage or a set… Read more about Treating Employees Differently: Employer Contribution Requirements
Spring Is Here! Health Wonk Review
Welcome to the Spring edition of the Health Wonk Review. With condolences to our east-coast and Great Lakes friends who have been dealing with what probably seems like 47 straight months of winter. Maybe they can call it the “Spring is eventually coming” edition? We’ve got a great round-up of health care articles in this… Read more about Spring Is Here! Health Wonk Review
State Approaches to Handling CSR Uncertainty for 2018 Premium
Joint post by: David Anderson, Charles Gaba, Louise Norris, Andrew Sprung Note: this post is a joint effort with colleagues who have closely tracked the CSR chaos induced by Trump and Republicans in Congress. Dave Anderson is a former health insurance analyst, now a health care scholar at Duke, and a blogger at Balloon Juice; Charles Gaba is… Read more about State Approaches to Handling CSR Uncertainty for 2018 Premium
The Neverending Summer of Healthcare Legislation Edition of the Health Wonk Review
Throughout 2017, nearly every week has seemed like a very big deal for health care reform. But this week is especially noteworthy, with bipartisan efforts to stabilize the individual insurance markets (cough… fund CSRs… cough), along with not one, but two major pieces of legislation unveiled on Wednesday: Senator Sanders’ single-payer bill (which garnered 16… Read more about The Neverending Summer of Healthcare Legislation Edition of the Health Wonk Review
Weekend reading recommendation: The Summer Lull edition of the HWR
Peggy Salvatore has done an excellent job with this week’s edition of the Health Wonk Review, hosted at her Health System Ed blog. There’s something for everyone, and it makes for some great weekend reading. Two of my favorites in this edition are Harold Pollack’s explanation of why red states that voted for Trump would… Read more about Weekend reading recommendation: The Summer Lull edition of the HWR
2017: Made for health wonks
Joe Paduda hosted the Health Wonk Review on Friday, and it’s a must-read edition. It coincided perfectly with the release of the long-awaited, top-secret Senate GOP health care reform bill, and Joe’s edition includes an everything-you-need-to-know summary of the Senate bill, written by the inimitable Tim Jost and Sara Rosenbaum. In related news, Joe is… Read more about 2017: Made for health wonks
IRS 2018 HSA Contribution Limits, Minimum Deductibles & Maximum Out-of-Pocket
The IRS published Revenue Procedure 2017-37 last week, specifying the IRS 2018 HSA contribution limits, along with the minimum deductibles and maximum out-of-pocket exposure for HSA-qualified plans. IRS 2018 HSA contribution limits * If you have individual coverage under an HSA-qualified plan: $3,450 (up from $3,400 in 2017) If you have family coverage under an… Read more about IRS 2018 HSA Contribution Limits, Minimum Deductibles & Maximum Out-of-Pocket
Groundhog Zombie Goes Back to the Future: AHCA Vote Day Health Wonk Review
Yesterday was a bit of a banner day in health care reform circles, with the passage of the AHCA in the House of Representatives. The vote came less than 24 hours after the final amendment was added to the bill, and before the CBO had scored the last three amendments that were added. It’s now… Read more about Groundhog Zombie Goes Back to the Future: AHCA Vote Day Health Wonk Review
Health care reform: What’s next in Colorado?
2017 has been a whirlwind year for health care reform. As rate filing season draws near, there is still considerable uncertainty surrounding the future of the ACA and what lies ahead for health care reform. Here’s a summary of where things stand in Colorado: Failed: Bill to extend premium help to people above 400 percent… Read more about Health care reform: What’s next in Colorado?
Pre-Passover edition of the HWR at InsureBlog
Hank Stern has done an outstanding job with the Health Wonk Review this week; don’t miss his pre-Passover edition. Hank has factoids about Passover interspersed with ten excellent articles from some of our favorite health wonks. Thanks for hosting, Hank, and Happy Passover!
AHCA: The Aye or Nay? Edition of the Health Wonk Review
Seven years ago today, President Obama signed the Affordable Care Act into law, ushering in a host of reforms for the U.S. health care system. And today, House Republicans are planning to vote on the American Health Care Act (AHCA), which would repeal many of the ACA’s spending-related provisions and implement replacements for some aspects of… Read more about AHCA: The Aye or Nay? Edition of the Health Wonk Review
What do the proposed HHS regulations mean for Colorado’s individual market?
HHS Secretary Tom Price was confirmed by the Senate last week, and the agency wasted no time in drafting new proposed regulations under his leadership. The new regulations are intended to stabilize the individual and small group health insurance markets. The comment period is only three weeks (it closes on March 7, 2017), which is… Read more about What do the proposed HHS regulations mean for Colorado’s individual market?
Health Wonks Wonder… Will ACA Repeal Really Happen?
Steve Anderson hosted this week’s “#Alternative_Facts” edition of the Health Wonk Review, at medicareresources.org. It’s an excellent edition, and each entry in framed in terms of an #alternative_fact… of course, the alternative-ness depends a bit on your perspective. My favorite? Joe Paduda’s assessment that ACA repeal isn’t actually going to happen soon, and might not… Read more about Health Wonks Wonder… Will ACA Repeal Really Happen?
Health Wonks know: Words Matter
Julie Ferguson hosted the “Words Matter” edition of the Health Wonk Review this week, at Workers’ Comp Insider. Julie did an excellent job, as always, and there’s plenty of good stuff in this edition of the HWR. Some of my favorites are: Joe Paduda’s at-a-glance summary of the direction the GOP is likely headed in terms… Read more about Health Wonks know: Words Matter
Puppies and kittens and the future of healthcare reform
Hank Stern hosted the Health Wonk Review this week, with a theme — Puppies and Kittens — designed to unite us around something we can all agree on, after a rough election season. There are tons of great entries in this edition of the HWR. Since I’m particularly focused on the future of healthcare reform,… Read more about Puppies and kittens and the future of healthcare reform
Don’t Get Caught By The ACA Individual Mandate Penalty – It’s much higher than it used to be
This post was originally written in March 2014, but was updated in November 2015 to reflect the changes in the penalty calculation for 2016, and again in November 2016 to address the penalty for 2017. The penalty in 2017 will remain unchanged from 2016, but it’s considerably higher than it was in 2014 or 2015,… Read more about Don’t Get Caught By The ACA Individual Mandate Penalty – It’s much higher than it used to be
You’re eligible for cost-sharing subsidies. Does that mean you should always pick a silver plan?
A recent article published by the Colorado Center on Law and Policy (CCLP) caught my attention on Twitter today. One part of the article stood out, and I wanted to address it here. The article states that “Anyone who purchases insurance on Connect for Health Colorado would be wise to check eligibility for assistance and,… Read more about You’re eligible for cost-sharing subsidies. Does that mean you should always pick a silver plan?