News
Most Counties Will Have Free 2018 Exchange Plans for Low-Income Enrollees
New analysis from Avalere finds that nearly 98% of counties with exchanges operated by HealthCare.gov will have free bronze plan options for low-income consumers aged 50 earning 150% of poverty or less ($18,090 for an individual or $36,900 for a family of four).
Silver Exchange Premiums Rise 34% on Average in 2018
New analysis from Avalere finds that the 2018 exchange market will see silver premiums rise by an average of 34%. According to Avalere's analysis of filings from Healthcare.gov states, exchange premiums for the most popular type of exchange plan (silver) will be 34% higher, on average, compared to last year.
Uncertainty Reigns as Consumers Begin to Make Health Insurance Decisions for 2018
Avalere experts preview the 2018 ACA open enrollment season
Administration’s Decision to End Cost-Sharing Reduction Payments Will Lead to Substantial 2017 Losses for Health Plans
New analysis from Avalere finds that the administration's decision last week to end federal funding for the cost-sharing reduction (CSR) payments could lead to substantial losses for health plans-ranging from -$1.2M in North Dakota to -$200M in Florida through the end of 2017 (Figure 1).
CMS Proposal for New Medicare Payment System Could Lead to Large Payment Variability for Specialists
New analysis from Avalere finds that payments to certain physician specialists could increase or decrease by as much as 16% for their 2018 performance under the Merit-based Incentive Payment System (MIPS).
Beneficiaries in Specialized Diabetes-Focused Medicare Plans Have Fewer Hospitalizations
Compared to beneficiaries with diabetes who are enrolled in other Medicare Advantage plans, enrollees in special needs plans experience better outcomes, after adjusting for demographic and clinical factors.
Updated Analysis: Revised Graham-Cassidy Bill Would Reduce Federal Funding to States by $205B
Avalere has updated its previous analysis to reflect the September 25 version of the Graham-Cassidy-Heller-Johnson (GCHJ) bill to repeal and replace the Affordable Care Act (ACA).
Graham-Cassidy-Heller-Johnson Bill Would Reduce Medicaid Funds to States by $713B Over the Next 10 Years
New analysis from Avalere finds that the Graham-Cassidy-Heller-Johnson (GCHJ) bill to repeal and replace the Affordable Care Act (ACA) would lead to a substantial reduction in federal Medicaid funding to states of $713B through 2026 and more than $3.5T over a 20-year period if block grant funding is not reauthorized (Figure 1).
Graham-Cassidy-Heller-Johnson Bill Would Reduce Federal Funding to States by $215B
New analysis from Avalere finds that the Graham-Cassidy-Heller-Johnson (GCHJ) bill to repeal and replace the Affordable Care Act (ACA) would lead to a reduction in federal funding to states by $215B through 2026 and more than $4T over a 20-year period (Table 1).
Exchange Reinsurance Stabilization Package Could Reduce 2018 Premiums by 17%
Market stabilization efforts could also lead to higher enrollment in exchanges.
Exchange Plans in Counties with the Least Insurer Competition Have the Highest Premiums
Benefit designs do not vary widely based on insurer competition, except for deductibles that are lower in areas with three or more insurers.
Cruz Amendment to BCRA Would Lead to Coverage Losses and Increased Premiums for Individuals with Higher Medical Expense
Affordable Care Act-compliant plan market would see 39% higher premiums, while non–ACA-compliant plans would have much lower premiums
New Medicare Incentives Encourage Accountable Care Organizations To Assume Greater Risk
Avalere simulation finds that more ACOs will be eligible for earnings if they take on two-sided risk.
Biosimilars Gain Widespread Adoption by Health Plans
New research from Avalere finds that most health plans are covering at least one of the two biosimilar products currently on the market.
Senate Health Bill to Reduce Federal Medicaid Funding to States
New analysis from Avalere finds that states could see federal funding for their Medicaid programs decline by between 6% and 26% under the Better Care Reconciliation Act (BCRA) by 2026.
Premium Increases and Fewer Insurers Participating Expected in Exchange Market in 2018
More than 40% of counties could see only one exchange plan in 2018, with risk that some counties may have no commercial options.
Physician Specialists Gain More Opportunities for Medicare Bonus Payments Tied to Quality
The number of CMS-approved QCDRs tied to payment grows by more than 60% in 2017.
Health Plans Are Actively Exploring Outcomes-Based Contracts
Avalere experts say use of outcomes-based contracts could further goals to improve patient outcomes and manage drug costs
Per Capita Caps Could Reduce Funding for Children Covered by Medicaid
All 50 states and DC would receive fewer Medicaid dollars for non-disabled children.
AHCA Will Remove Low Cost-Sharing Guarantees for Low-Income Individuals
The elimination of cost-sharing reductions could lead to low-income individuals facing higher deductibles and maximum out-of-pockets.