What new rules will apply to insurers to make coverage more accessible and affordable?
Beginning in 2011, the Affordable Care Act (ACA) requires insurance plans to pay out a minimum percentage of premium dollars towards health care expenses and quality improvement activities, limiting the amount spent on administrative and marketing costs and profit. Under the law, large group plans are required to spend at least 85 percent of premium dollars on health care and quality improvement, while small group plans must spend at least 80 percent. These ratios are known as the Medical Loss Ratio (MLR). This analysis looks at the latest estimates provided by insurers to state insurance commissioners.
This data note provides estimates of the potential cost-sharing levels for plans that will be available in the non-group market (including in new health insurance exchanges) when the ACA is fully implemented in 2014. It builds on previous work from Kaiser and reflects recent guidance from the federal government on benefits and cost-sharing for plans offered in those markets.
In his latest column, Kaiser Family Foundation President Drew Altman looks at the falloff in utilization of health services.
This fact sheet provides highlights from an analysis tracking the flow of federal Affordable Care Act funds to states as reporter in the Department of Health and Human Services grant database as well as periodic reports from HHS and the Internal Revenue Service.
This tool allows users to track funds awarded by the Affordable Care Act (ACA) to a variety of governmental and private entities. This funding will go to states, local governments, employers, community health groups and health care providers to implement various provisions aimed at transforming areas of the existing health system and making health insurance coverage more affordable.
Guidance from the Department of Health and Human Services (HHS) that outlines HHS's "approach to implementing a Federally-facilitated Exchange (FFE) in any State where a State-based Exchange is not operating. In addition to describing our high-level operational approach, we discuss: 1. How States can partner with HHS to implement selected functions in an FFE, 2. Key policies organized by Exchange function, and 3. How HHS will consult with a variety of stakeholders to implement an FFE."
Final rule from the Department of Health and Human Services on the Medical Loss Ratio requirements under the Affordable Care Act. The final rule "amends the regulations implementing medical loss ratio (MLR) standards for health insurance issuers under the Public Health Service Act in order to establish notice requirements for issuers in the group and individual markets that meet or exceed the applicable MLR standard in the 2011 MLR reporting year." The rule "establishes a simple, straightforward notice requirement for health insurance issuers that meet or exceed the MLR standards established by the Affordable Care Act, but only requires the notice for the 2011 MLR reporting year, the first year that the MLR rules are in effect, and does not require issuers to include information about the current or prior year MLR. The notice will direct enrollees to the HHS Web site for specific information about issuers’ MLRs."
Compare information across states about what they are doing to create and implement health insurance exchanges, including the status of state action, how their exchanges will be governed and total federal exchange grants.
Who will be required to purchase health insurance under the health reform law? This simple flowchart illustrates a provision referred to as the "individual mandate."
A summary of coverage provisions in the Patient Protection and Affordable Care Act.
Will everyone have to buy insurance? What will be covered in the health insurance offered under health reform? Learn more about the changes to insurance through our FAQs.