United Benefit Advisors Insight and Analysis Blog

President Trump Ends ACA Cost Sharing Reductions

Posted by: Danielle Capilla    Oct 17, 2017 9:30:00 AM

On the evening of October 12, 2017, President Trump announced that cost sharing reductions for low income Americans in relation to the Patient Protection and Affordable Care Act (ACA) would be stopped. The Department of Health and Human Services (HHS) has confirmed that payments will be stopped immediately. While there is no direct impact to employers at this time, UBA will continue to educate employers about changes in the law and its Health Plan Survey will continue to track group health plan rates over time as insurance companies potentially seek to recoup lost revenue. It is anticipated at least some state attorneys general will file lawsuits to block the ending of the subsidy payments, with California Attorney General Xavier Becerra stating he is prepared to file a lawsuit to protect the subsidies.

Read More

Topics: health insurance exchanges, Cost-Sharing, group health insurance, Affordable Care Act

Preventive Services Final Rules

Posted by: Danielle Capilla    Aug 6, 2015 12:00:00 PM

Federal agencies released final regulations on the preventive services mandate of the Patient Protection and Affordable Care Act (ACA) that requires non-grandfathered group health plans to provide coverage without cost-sharing for specific preventive services, which for women include contraceptive services.

Read More

Topics: ACA, PPACA Affordable Care Act, contraception coverage, religious opposition to contraception, Cost-Sharing, group health insurance, preventive services, Danielle Capilla

Cost Sharing Limits Changing for 2016

Posted by: Danielle Capilla    Apr 7, 2015 12:00:00 PM

In the Benefit and Payment Parameters for 2016 Final Rule issued in February 2015, federal agencies included a clarification that annual cost-sharing limitations for self-only coverage apply to all individuals, regardless of whether the individual is covered by a self-only plan or is covered by another kind of plan. Cost sharing refers to out-of-pocket expenses and deductibles that are paid by the beneficiary. In both self-only and other plans, an individual’s cost sharing for essential health benefits (EHBs) may never exceed the self-only annual limitation. The information was only included in the preamble of the Final Rule, and was not included into the regulatory language. As a result, the benefits industry was left unsure of the implications.

Read More

Topics: Cost-Sharing

Reference-Based Pricing and Cost-Sharing Limits

Posted by: Linda Rowings    Nov 11, 2014 10:19:00 AM

The Department of Labor (DOL), the IRS, and the Department of Health and Human Services (HHS) have jointly issued a FAQ that addresses how "reference-based pricing" works with the Patient Protection and Affordable Care Act's (PPACA) restrictions on out-of-pocket maximums. PPACA limits the out-of-pocket maximum a non-grandfathered plan may impose, and generally requires that co-pays, coinsurance, and deductibles be counted toward this limit. However, premiums, balance billed amounts for non-network providers, and non-covered services do not need to be applied to the out-of-pocket limit. (For 2015, the limits are $6,600 per individual or $13,200 per family.) The new FAQ explains how the out-of-pocket limit applies to plans that use reference-based pricing--i.e., a design under which the plan pays a fixed amount for a particular procedure (such as a knee replacement), which certain providers have agreed to accept as full payment.

Read More

Topics: Linda Rowings, IRS, HHS, DOL, Reference-Based, Pricing, Cost-Sharing, Limits, Department of Labor, Department of Health and Human Services