Benefits Analysis
Since benefit design can have a significant impact on access to care and utilization of health services, it is important for states to understand benefit packages in the existing insurance market before designing policies to incorporate ACA-related changes.
*Milestone details:
*Full name: Assess the benefit packages found in the state’s large group, small group, and individual markets, state employee health plan, and Medicaid and CHIP programs to determine the current state of the market.
*Relevance to the ACA:
In order to analyze the impact of ACA benefit requirements and options on their insurance markets, states must first understand the existing market. The ACA does not require states to conduct this assessment. Relevant provisions of the ACA include:
§1001 – Eliminates lifetime and annual limits; prohibits cost-sharing for certain preventive services; extends dependent coverage to age 26.
§1251 – Allows existing insurance plans to continue operating under “grandfather” status.
§1302 – The Secretary of Labor will conduct a survey of employer-sponsored insurance plans to determine what benefits are typically covered.
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District of Columbia
The Children's Dental Health Project (CDHP), along with 18 other organizations submitted the attached comments in response to the December 16, 2011 HHS Bulletin on Essential Health Benefits.
In addition to expressing concerns around dental benefit design and consumer protections in the Exchanges, the letter provides a snapshot of how the benchmark plans, including some CHIP plans would impact families purchasing pediatric dental coverage through the Exchanges.
Contact Colin Reusch at creusch@cdhp.org with questions.
Virginia
I'm curious how states have gone about the process of assessing what mandated insurance benefits they may or may not continue if they are not determined to be part of the essential health benefits package?
District of Columbia
Earlier this month, Massachusetts released a report on health care cost trends. The report also includes an over view of plan benefits in the state.
Massachusetts
A toolkit published by the Blue Cross Blue Shield of Massachusetts entitled "Determining Health Benefit Designs to be Offered on a Health Insurance Exchange" provides resources helpful to other states in developing benefit packages.
The toolkit is one in a series of five toolkits publised by the BCBSMA Foundation wtih funding support from the Robert Wood Johnson Foundation and developed in collaboration with the Massachusetts Health Insurance Connector Authority and the Massachusetts Office of Medicaid.
District of Columbia
This powerpoint gives an overview of the benefit design of public insurance programs in D.C. and how this will be impacted by ACA
District of Columbia
These report summarize WI's individual, small, and large group health insurance markets.
Wisconsin
Study completed in August 2011 by Gorman Actuarial and J. Gruber on "The Impact of the ACA on Wisconsin's Health
Insurance Market." Also, the Walker Administration's perspective on the report, as reflected in the press release and ppt presentation to reporters.
District of Columbia
This report by the New York State Health Foundation details the challenges and opportunities NY faces in implementing reform, including Exchange, benefit design and payment issues. Access the report here: http://www.statereforum.org/sites/default/files/nyroadmappaper_aug2010.pdf
District of Columbia
This application outlines WV's plans for the Exchange and how they would use the grant funds, including surveys and stakeholder engagement. Access the grant here:
http://www.statereforum.org/sites/default/files/wv_peg_grant_application...