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Tag: Health Insurance Marketplace (page 1 of 4)

Three States Bar Issuers from Increasing Rates

Sean Kirschner

Sean is a Business Analyst at Softheon. His objective is to provide insight into the current state of the healthcare landscape through research on both business and policy. He is also responsible for assisting the research team through creating and maintaining research briefings on various industry topics. He earned his bachelor’s degree in economics from Boston College.

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UPDATE: On October 26th, North Dakota’s insurance commissioner announced that Sanford Health Plan will return to ND’s individual exchange for 2018, but only in 5 counties. Sanford’s Executive Vice President, Kirk Zimmer stated that the move was due to the Trump administration’s decision to cut off insurer subsidies.

Though the start of the 2018 Open Enrollment Period (OEP) is only a week away, there is unprecedented uncertainty around the Exchanges and federal funding established by the Patient Protection and Affordable Care Act (ACA). Despite this, three states have decided to hold their ground and block issuers from increasing member premiums for 2018.  

With rumors that the White House was considering ending cost-sharing reduction payments, many health insurance carriers increased their 2018 premium rates to account for the loss of government funding. Since the official decision to end the payments on October 12, even more health plans have raised their rates through an informal offer by the Department of Health and Human Services (HHS), allowing carriers to adjust their premium rates right up until OEP 2018 on November 1st (1).  

While insurers in all 50 states, plus D.C., have requested the approval of rate hikes, the insurance commissioners of Minnesota, North Dakota, and Vermont have unilaterally declared that they will deny any such request by insurers participating in their exchanges. They reason that the effect would be too severe with such little time until OEP 2018 begins on November 1st, justifying that their purpose is to protect consumers though whatever measures they can take. 

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August Round Up: CMS Announces OEP Procedures; Senate Schedules Hearings; Navigator Funding; Bare Counties

Yvonne Villante
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Yvonne Villante

Director of Marketing at Softheon
Yvonne Villante is the Director of Marketing at Softheon. Before this, Yvonne held several roles within the organization including Senior Research Manager, Corporate Research Manager, and Marketing Research Analyst. She holds a MBA in healthcare administration from Ohio University and a BS in business management from SUNY Stony Brook. During her undergraduate studies, she graduated within the top 10% of her class.
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On August 28, 2017, the Centers for Medicare and Medicaid Services released information providing insight into the procedures that it intends to follow for the 2018 open enrollment period. There are some new policies in place for the 2018 plan year, many of which have been introduced by the market stabilization rule:

Payments Rule

CMS has announced a new rule which will permit payments for new enrollees to be applied for past-due premiums owed to the insurer or an insurer in the same group. According to the released information, if payment of applicable past-due premiums and a new binder is not received for the new coverage, the insurer may refuse to effectuate coverage. The rule will allow a look-back period of up to 1 year, however the look-back period for 2018 coverage cannot extend beyond June 19, 2017. Insurers must have described its nonpayment policy in its application materials and in any notice of nonpayment of premiums. The policy may only be applied to enrollees that have received notice before failing to pay their premium that has become past-due, and only to enrollees who were contractually responsible for the nonpayment.

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5 Reasons Why More People Will Enroll for OE2017 Than Ever Before

Yvonne Villante
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Yvonne Villante

Director of Marketing at Softheon
Yvonne Villante is the Director of Marketing at Softheon. Before this, Yvonne held several roles within the organization including Senior Research Manager, Corporate Research Manager, and Marketing Research Analyst. She holds a MBA in healthcare administration from Ohio University and a BS in business management from SUNY Stony Brook. During her undergraduate studies, she graduated within the top 10% of her class.
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Why More People Will Enroll for OE2017 Than Ever Before

Despite post-election uncertainties surrounding the healthcare reform laws, the Centers for Medicare & Medicaid Services (CMS) and the Internal Revenue Service (IRS) are pushing full steam ahead to enroll more people.

The Department of Health and Human Services (HHS) is expecting 13.8 Million to sign up for coverage – a 9.9 percent rise compared to the 12.7 Million who gained coverage last year [1].

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Do You Know Who Your Exchange Members Are?

Umer Mujeeb

Umer is the Director of Software Engineering, where he specializes in big data analytics and reporting. Prior to this position, he served as Softheon’s Lead BI & Data Engineer. He also worked as a Big Data Business Analyst for an enterprise data analytics technology firm. He received his undergraduate degree in physics and mathematics and master’s degree in applied mathematics from Stony Brook University.

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Everyone is talking about Big Data, but how can it really help you understand your exchange membership?

The Affordable Care Act (ACA) requires health plans to upload de-identified enrollment, medical claims, and pharmacy claims data to EDGE Servers for accurate risk score calculators, for both Risk Adjustment (RA) and Reinsurance (RI). These advanced analytical methods can offer diverse insight into consumers’ healthcare consumption behaviors and cost utilization by using numerous key performance indicators (KPIs) such as demographics, age, and gender.

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Inside the Marketplace: What do Mega-Mergers Mean for Payers and Consumers?

Yvonne Villante
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Yvonne Villante

Director of Marketing at Softheon
Yvonne Villante is the Director of Marketing at Softheon. Before this, Yvonne held several roles within the organization including Senior Research Manager, Corporate Research Manager, and Marketing Research Analyst. She holds a MBA in healthcare administration from Ohio University and a BS in business management from SUNY Stony Brook. During her undergraduate studies, she graduated within the top 10% of her class.
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Inside the Marketplace Blog Series, No. 4

Robert Miller

The health insurance industry is undergoing several long-anticipated mergers. Since their initial announcements nearly a year ago, many of these mergers and acquisitions (M&A) have since gained public controversy. With the Department of Justice (DOJ), states, and consumer advocacy groups currently debating their merits, this topic continues to have a large impact on the industry. Here, Robert Miller, Managing Director of Healthcare Reform at Softheon, shares his thoughts on what these mega-mergers mean for healthcare payers and consumers.

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Inside the Insurance Marketplace: Despite Some Exits, Why Most Health Plans Will Stay Put

Yvonne Villante
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Yvonne Villante

Director of Marketing at Softheon
Yvonne Villante is the Director of Marketing at Softheon. Before this, Yvonne held several roles within the organization including Senior Research Manager, Corporate Research Manager, and Marketing Research Analyst. She holds a MBA in healthcare administration from Ohio University and a BS in business management from SUNY Stony Brook. During her undergraduate studies, she graduated within the top 10% of her class.
Yvonne Villante
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Inside the Marketplace Blog Series, No. 3

Daniel Hughes, Despite Some Exits, Why Most Health Plans Will Stay PutWhile several big name health plans have announced their exit from the Affordable Care Act (ACA) Marketplace, others are willingly rising up to the opportunity to take their place. Some are entering areas that have experienced lost competition, while others are expanding their exchange business into new geographical markets. Here, Dan Hughes, Managing Director of Sales at Softheon, shares his thoughts on why despite some of these exits, most health plans will stay put.

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Inside the Marketplace: How Millennials are Shaping the Health Insurance Industry

Yvonne Villante
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Yvonne Villante

Director of Marketing at Softheon
Yvonne Villante is the Director of Marketing at Softheon. Before this, Yvonne held several roles within the organization including Senior Research Manager, Corporate Research Manager, and Marketing Research Analyst. She holds a MBA in healthcare administration from Ohio University and a BS in business management from SUNY Stony Brook. During her undergraduate studies, she graduated within the top 10% of her class.
Yvonne Villante
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Inside the Marketplace Blog Series, No. 2

Matt Schumpf, millennials are shaping the health insurance industryDigital natives by nature, millennials are shaping the health insurance industry. With an increased reliance on digital technology, this group has caused a shift that has undoubtedly disrupted the health insurance world. Here, Matt Schumpf,  Director of Healthcare Reform Solutions at Softheon, shares his thoughts on how millennials are shaping the health insurance industry.

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Health Plans, and Brokers are Expanding Ancillary Product Offerings, Embracing One-Stop Shopping

Reshika Mahase

Senior Product Manager at Softheon
Reshika Mahase is the Product Owner for Clarity and Welltheos solutions, where she is responsible for product development and improvements. Reshika has worked on a number of projects during her years at Softheon, including private health plans, Welltheos, and Marketplace Exchange UX/UI.She earned both her MBA in Information Systems Management and BBA from Dowling College.

Looking to offer employers and consumers with a one-stop shopping experience, health plans are aggressively adding ancillary products to their private exchanges?

Ancillary services are employee offerings that don’t fall under major medical coverage; auxiliary or supplement services used to support diagnosis and treatment of a patient’s condition.  Integrating ancillary services can help to improve health plan profit margins, complementing health insurance offerings that are offered on the Marketplace. When properly integrated, ancillary services can help control costs, provide additional revenue streams, and enhance convenience for busy patients.

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Inside the Insurance Marketplace: Why There Isn’t a One-Size-Fits-All Model

Yvonne Villante
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Yvonne Villante

Director of Marketing at Softheon
Yvonne Villante is the Director of Marketing at Softheon. Before this, Yvonne held several roles within the organization including Senior Research Manager, Corporate Research Manager, and Marketing Research Analyst. She holds a MBA in healthcare administration from Ohio University and a BS in business management from SUNY Stony Brook. During her undergraduate studies, she graduated within the top 10% of her class.
Yvonne Villante
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Inside the Marketplace Blog Series, No. 1

The healtDana Frankehcare industry has undergone significant change over the last decade. Making way for the transformation of new approaches to interact and communicate with consumers, such as retail store locations and mobile shopping & payment applications, the shift toward B2C has disrupted the traditional healthcare payer’s distribution channel. In today’s market, where the one-size-fits-all model is not effective, meeting consumer demands will demand new and innovative methods. Here, Dana Franke, Director of Operations at Softheon, shares her thoughts.

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Introducing Inside the Marketplace: A Softheon blog series.

Yvonne Villante
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Yvonne Villante

Director of Marketing at Softheon
Yvonne Villante is the Director of Marketing at Softheon. Before this, Yvonne held several roles within the organization including Senior Research Manager, Corporate Research Manager, and Marketing Research Analyst. She holds a MBA in healthcare administration from Ohio University and a BS in business management from SUNY Stony Brook. During her undergraduate studies, she graduated within the top 10% of her class.
Yvonne Villante
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Softheon will be rolling out a blog series, each focusing on a critical Patient Protection and Affordable Care Act (PPACA) topic.

Have you been wondering how certain topics will affect consumers, healthcare payers, and other stakeholders?

Here’s your chance to find out.

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