Georgia Revises Proposal to Decentralize ACA Marketplace

September 11, 2020

Georgia recently reaffirmed its proposal to make dramatic changes in its individual market, saying it plans to abandon the Affordable Care Act (ACA) marketplace in favor of a new state program despite the widespread disruptions in health care and health insurance brought by the coronavirus pandemic.

In its revised Section 1332 waiver request to CMS, Georgia said it wanted to push back the start date for part of its plan, meaning the proposal’s two parts — the new state marketplace and a new reinsurance program — wouldn’t take effect until 2022.

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PreferredOne is exiting Minnesota's marketplace for 2015

September 22, 2014

Saying the business was not sustainable, PreferredOne, the top selling insurer on the Minnesota public exchange MNSure, is exiting the marketplace for 2015. Four Minnesota-based insurers will participate on the exchange next year: Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica and UCare Health Plan, Inc. Visit tinyurl.com/kyfa9t6.

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PBM Execs Make Marketplace Predictions for 2015

January 9, 2015

For our annual series of Outlook stories, DBN asked the top execs of stand-alone and insurer-owned PBMs to look into their crystal balls for 2015 and consider the question: What marketplace dynamics are likely to have the biggest impact on the PBM industry? Here’s what a few had to say: “One area that will have […]

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Friday Health Plans Gains Foothold in Colorado Marketplace

February 3, 2020

Despite Colorado’s robust insurance market, relative newcomer Friday Health Plans has managed to gain traction in its first few years. The company recently inked a $50 million funding agreement that may help it expand into new territories and provide the necessary tools to increase enrollment.

Launched by Sal Gentile, CEO, and David Pinkert, president, both health care industry veterans, Friday Health got its start as the two realized that the market was changing with individuals making more decisions, Gentile tells AIS Health. “The inspiration came from watching the development of the market, believing what ultimately would become a consumer-based market…and that plans, operations and tools were going to be necessary to be focused on the health care consumer.”

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Fifteen States Saw Higher Marketplace Enrollment in 2018

July 2, 2018

While the number of people selecting Affordable Care Act marketplace plans decreased by an average of 3.8% nationwide from 2017 to 2018, 15 states saw an increase in marketplace sign-ups. Rhode Island, Kentucky and Washington saw the biggest increases, boosting enrollment by 12.1%, 10.4% and 7.8%, respectively. Louisiana saw the biggest drop, with 23.5% lower […]

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Initiative Could ‘Fundamentally Change’ IV Oncology Marketplace

March 1, 2016

In a proposed rule unveiled March 8 (81 Fed. Reg. 13230), CMS says it will test various Medicare Part B reimbursement models (see story, p. 1). The most widely reviled by stakeholders would change reimbursement from average sales price +6% to ASP +2.5% plus a payment of $16.80 per drug per day. SPN spoke with […]

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Truveris launches first U.S. pharmacy benefit marketplace

September 26, 2014

Truveris on Sept. 22 launched RxChoice, which the pharmacy benefit pricing and analytics company says is the first U.S. pharmacy benefit marketplace. Pharmacy benefit brokers and health plan advisers can log into www.rxchoice.com to generate free pharmacy benefit quotes from vendors by accessing pre-negotiated contracts and highly competitive pricing in minutes, says Truveris. The new […]

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U.S. Blames Drug Shortages on Low Prices and a ‘Broken Marketplace’

October 29, 2019

Chronic drug shortages that threaten patient care are caused by rock-bottom prices for older generic medicines and a health care marketplace that doesn’t run on the rules of supply and demand, among other factors, according to a federal report published on Tuesday.

The report, the work of a task force led by the Food and Drug Administration and comprising representatives from various federal agencies, recommended that buyers like hospitals consider paying higher prices for older generic drugs.

Chronic drug shortages that threaten patient care are caused by rock-bottom prices for older generic medicines and a health care marketplace that doesn’t run on the rules of supply and demand, among other factors, according to a federal report published on Tuesday.

The report, the work of a task force led by the Food and Drug Administration and comprising representatives from various federal agencies, recommended that buyers like hospitals consider paying higher prices for older generic drugs.

Paying more would encourage drug companies to prioritize drugs like vincristine, a critical cancer medicine for children that now sells for just $8 a vial. To the consternation of cancer specialists, supplies of the drug recently have been scarce….

Read the full The New York Times article

Average Premiums on kynect Individual Marketplace, 2016 vs. 2015

October 26, 2015

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2015 Public Marketplace Enrollment Round-Up and Results, by State

June 15, 2015

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Specialty Copay Coinsurance Levels for CO-OPs on the Individual Marketplace

April 1, 2014

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Congress Battles Over the Fate of ACA Marketplace via Tax Bill

December 18, 2017

Earlier this year, the Trump administration and Congress agreed that the Affordable Care Act (ACA) health insurance exchanges should be stabilized, but now it appears the effort remains in the hands of only a few senators. As the GOP forges ahead on a tax overhaul that includes eliminating the individual mandate, Sen. Susan Collins (R-Maine) […]

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Average Premiums for Insurers on D.C. Individual Marketplace, 2016 vs. 2015

November 9, 2015

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Not-for-Profits Feel Margin Pressures as Marketplace Shifts Fuel Cost Increases

March 9, 2015

Not-for-profit insurers, be they organized as mutuals or part of a larger corporate structure, are navigating the changing industry like publicly traded carriers, but some have run into more headwinds of late as the cost of shifting their business models to focus on individual and small-group products on public exchanges has taken its toll. Blue […]

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Blue Cross and Blue Shield of Nebraska will pull out of the individual marketplace for 2018

June 12, 2017

An earlier version of this brief failed to clarify that Blue Cross and Blue Shield of Nebraska is exiting the off-exchange individual market for 2018. The insurer already had left the state’s exchange at the end of 2016. This version has been corrected. Blue Cross and Blue Shield of Nebraska said it will pull out […]

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Mid-2016 Check: Pressures on Health Plans Build in Fast-Changing Marketplace

June 6, 2016

An HPW survey of health insurance industry specialists on what they see as the issues carriers should be most concerned about entering the second half of 2016 into next year reflects the array of challenges these businesses face. From head scratching over which insurers will pick up market share in states where UnitedHealth Group has […]

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Average health insurance premium in the federal marketplace is $113 after tax credits

February 15, 2016

The average health insurance premium in the federal marketplace is $113 after tax credits, HHS said recently. Eighty-three percent of applicants qualified for an average tax credit of $294 per month, which equaled 72% of the original premium. Sixty-three percent of returning users switched plans in 2016, saving an average of $43 per month. HHS […]

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Proposed rate increases for 2015 were lowest among the smallest operators on the marketplace

June 23, 2014

In a study of Washington state’s public exchange released on June 12, Washington, D.C.-based consultancy Avalere Health LLC said proposed rate increases for 2015 were lowest among the smallest operators on the marketplace. Molina Healthcare, Inc., which has around 1% of the state exchange enrollment for 2014, proposed a nearly 7% average rate cut for […]

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Average Premiums for Insurers On Access Health CT Individual Marketplace, 2016 vs. 2015

November 2, 2015

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Georgia has the highest percentage of narrow-network plans in its health insurance marketplace

September 21, 2015

Georgia has the highest percentage of narrow-network plans in its health insurance marketplace, according to a recent study funded by the Robert Wood Johnson Foundation. Researchers at the University of Pennsylvania Leonard Davis Institute of Health Economics analyzed provider networks of 90% of the silver-tier health plans offered in 2014, finding that Georgia had the […]

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