Federal & State Policy
As the largest, single US healthcare payer, the government plays a dominant role in shaping the healthcare marketplace. Our experts track, interpret, and model federal and state policies that affect insurance coverage, access, and consumer choice so you can see around the bend.
Featured Content
Effect of Potential Policy Change to Part D Generic Tiering on Patient Cost Sharing and Part D Plan Costs
In a new analysis, Avalere examines the implications of CMS’ potential new requirement that Part D plans place generics only on generic tiers.
Medicare Reimbursement of Virtual Care Delivery and Remote Monitoring
Beginning in 2019, CMS will reimburse for 5 codes relating to virtual care delivery and remote monitoring
Uses and Limitations of Medicare Advantage Encounter Data
In a recent post on the Health Affairs Blog, we examine the potential uses and limitations of Medicare Advantage (MA) encounter data.
HHS Proposed Changes Could Reduce ACA Coverage and Increase Premiums
New analysis from Avalere finds that exchange plan sign-ups could decline by 1.1 million, while premiums could increase by 6.3%, by 2025 should HHS finalize recently proposed changes to auto-reenrollment in the exchange and the calculation of tax credit subsidies.
Avalere Welcomes Jason Altmire as Senior Advisor
Former U.S. Congressman Jason Altmire has joined Avalere Health as a senior advisor, offering his deep understanding of the policy-making process to inform business strategy.
CMS Highlights Potential Changes that Could Restrict Access to and Increase the Costs of Certain Brand Drugs to Obamacare Enrollees
The Centers for Medicare & Medicaid Services released the proposed Notice of Benefit and Payment Parameters (NBPP) for the 2020 plan year. The rule could limit exchange plan enrollees' access to certain brand name drugs and increase the out-of-pocket costs within plans.
Landscape for Diagnostics Will Continue to Change in 2019
While precision medicine is expected to revolutionize patient therapy, the increasing complexity of diagnostics is leading policymakers to revamp the way these tests are regulated and paid for.
Podcast: Key Takeaways on the Ruling Declaring the Affordable Care Act Unconstitutional
Listen to Avalere experts discuss the implications for a recent decision ruling the Affordable Care Act is Unconstitutional.
New HRA Rule Could Reshape Enrollment and Access in Individual and Employer Markets
A proposed rule released by the Treasury Department, Department of Labor, and Department of Health and Human Services would expand the allowed uses of employer-sponsored Health Reimbursement Arrangements (HRA). Comments on the rule can be submitted until December 28, 2018.
Free Exchange Plan Options Are Available in Most Counties for 2019
New analysis from Avalere finds that over 95% of counties with exchanges operated by HealthCare.gov have free plan options for low-income consumers.
Podcast: E2 – 8 Rules for Implementing New Medicare Advantage Supplemental Benefits
Check out the second episode of our series on new supplemental benefits offered through Medicare Advantage plans for 2019 where Kenny Kan and Erica Breese discuss the "rule of 8".
Health Plans with More Restrictive Provider Networks Continue to Dominate the Exchange Market
Narrow network plans comprise nearly three-quarters of the exchange market.
Out-of-Pocket Costs for Oncology Drugs Vary Substantially Between Employer and Non-Employer Based Part D Plans
New Avalere analysis finds that beneficiaries enrolled in Employer Group Waiver Plans (EGWPs) have lower out-of-pocket (OOP) costs for select drugs than beneficiaries enrolled in other types of Part D plans.
Podcast: E3 – Trends in Health Policy and the Mid-Term Elections Results
Tune in to the last episode of our mid-term elections series to hear Avalere experts Chris Sloan and Elizabeth Carpenter discuss potential implications on health policy.
Podcast: E2 – Key Mid-Term Elections Driving Medicaid Expansion to Watch
Tune in for episode 2 of our mid-term elections podcast. Avalere experts, Chris Sloan and Tiernan Meyer, discuss potential state and federal-level scenarios for Medicaid expansion.
Podcast: E1 – Impacts the Mid-Term Elections Could Have on Pre-Existing Conditions
Tune in to hear the first episode in our 3-part series covering the mid-term elections and potential implications on health policy. Avalere expert, Chris Sloan, discusses potential implications of the mid-term elections on health policy. To kick off the series Avalere Founder, Dan Mendelson, covers pre-existing conditions.
2.7 Million People Could Gain Access to Medicaid Coverage Based on Outlook for State Elections
New analysis from Avalere finds that 2.7 million individuals from states that have not expanded Medicaid could gain Medicaid coverage should their newly elected governors decide to expand the program or states pass expansion referenda on their ballots.
Repeal of ACA’s Pre-Existing Condition Protections Could Affect Health Security of Over 100 Million People
New analysis from Avalere finds that 102 million individuals, not enrolled in major public programs like Medicaid or Medicare, have a pre-existing medical condition and could therefore face higher premiums or significant out-of-pocket costs if the ACA’s pre-existing condition protections were repealed.
Podcast: E1 – New Supplemental Benefits Offered Through Medicare Advantage Plans
In episode 1 of our series Fred Bentley, Sean Creighton, and Kenny Kan discuss the new supplemental benefits offered through Medicare Advantage plans for 2019.
CMS HCC Risk Adjustment Model 2019: Winners & Losers
Our analysis finds there will be winners and losers at the plan level under the new models.
