Coverage

Preventing Unwarranted Exceptions to the Affordable Care Act’s Medical Loss Ratio (MLR) Requirements

Starting in 2011, the Affordable Care Act requires insurers to spend a specific share of premium dollars on medical care, as opposed to administration, marketing, and profits. If insurers don't meet t...

Express Lane Eligibility: Early State Experiences and Lessons for Health Reform

How can your state improve its enrollment processes for Medicaid and CHIP? The Express Lane Eligibility provisions in the Children's Health Insurance Program Reauthorization Act (CHIPRA) give states n...

Buyer Beware: Unlicensed Insurance Plans Prey on Health Care Consumers

Three companies have been liquidated by court order for scamming health care consumers. Insurance departments in some states have found that these companies sold unauthorized, unlicensed health insura...

Grandfathered Plans under the Patient Protection and Affordable Care Act

A "grandfathered" plan is a health insurance plan that existed before the Affordable Care Act passed on March 23, 2010. Grandfathered plans do not need to meet the same criteria as plans sold to peopl...

Medicaid Expansion Helps Low-Wage Workers: Non-Expansion States

Many of the hard-working people engaged in jobs we rely on every day—from child care aides to bus drivers to waitresses—lack access to affordable health insurance. We recently examined data showin...

A 50-State Look at Medicaid Expansion

Update 11/07/18: Three states, Idaho, Nebraska, and Utah, passed ballot measures to expand Medicaid. Update 11/01/18: Enrollment begins in Virginia's Medicaid expansion; coverage starts January 1, ...

Medicaid Expansion Toolkit

As state health care leaders look to leverage new opportunities to expand Medicaid in 2019, Families USA’s Medicaid Expansion Leadership Team (MELT) is developing resources and guides to assist st...

Trump Administration Proposed 2020 Marketplace Rule: Key Health Consumer Issues

On January 17, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule that would raise consumers’ out-of-pocket costs for health care under individual and employer-sponsored ...

Trump Administration Proposal Redefines Poverty to Raise Health Care Costs for Middle-Class Families

For the second time in less than a month, the Trump administration has proposed obscure bureaucratic formula changes that will raise health care costs for 8.2 million people who buy private insurance ...

Final 2020 Health Insurance Marketplace Rules Are a Mixed Bag for Consumers

On April 18, 2019, the Trump Administration finalized the Notice of Benefit and Payment Parameters for 2020 (NBPP). This rule will govern health insurance marketplaces and set the framework for insu...