The Biden-Harris Administration Celebrates the 13th Anniversary of the Affordable Care Act

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Thirteen years ago, the Affordable Care Act (ACA) was signed into law with the goal of expanding access to affordable and quality healthcare for all Americans. Since then, the ACA has been a cornerstone of the American healthcare system, providing coverage to millions of previously uninsured people.

This year, on the 13th anniversary of the ACA, the Biden-Harris Administration is celebrating the law’s achievements and highlighting the record number of people who have signed up for health insurance through the ACA’s marketplace.

One of the most significant achievements of the ACA is the creation of the Affordable Care Act insurance Marketplace. The Marketplace provides a platform for individuals and small businesses to compare and purchase health insurance plans that meet their needs and budgets. Over the past 13 years, the Marketplace has helped 16 million people gain access to affordable health insurance, and this year’s open enrollment period saw record-high enrollment numbers.

The healthcare marketplace open enrollment period for 2023 began on November 1, 2022, and ended on December 15, 2022. According to the 2023 Open Enrollment Report, released by the Centers for Medicare & Medicaid Services (CMS), over 12 million people enrolled in health insurance plans through the Marketplace during this period. This represents a 23% increase from the previous year’s open enrollment period.

The Biden-Harris Administration has been working tirelessly to improve the ACA and make healthcare more accessible and affordable for all Americans. One of their recent efforts includes expanding eligibility for premium tax credits, which help reduce the cost of health insurance for those who qualify. This expansion is expected to provide additional financial assistance to over four million people.

The Administration has also taken steps to strengthen the ACA’s protections for people with pre-existing conditions, which ensure that they cannot be denied coverage or charged more for their healthcare. Additionally, the Biden-Harris Administration has launched a special enrollment period for those who were affected by the COVID-19 pandemic, providing them with additional opportunities to enroll in health insurance coverage.

The ACA has been a game-changer for millions of Americans, and the Biden-Harris Administration is committed to ensuring that it continues to provide access to affordable and quality healthcare. As we celebrate the 13th anniversary of the Affordable Care Act, we can look back with pride at the progress we have made and look forward to continuing to build a healthcare system that works for everyone.

Agility agents, check out our ACA resources page for more information!

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Exploring the Utilization of Preventive Services by Individuals with Private Insurance Coverage: A Closer Look at Healthcare Prevention

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The Affordable Care Act (ACA) brought many changes to the healthcare industry, including provisions that require most private health plans to cover preventive services at no cost-sharing for their enrollees. This means that individuals with private insurance coverage can receive important preventive services without having to pay out of pocket.

The ACA mandates that private health plans cover in-network preventive services at $0 cost-sharing for enrollees. This includes a wide range of preventive services, such as cancer screenings, vaccinations, and counseling for tobacco use. These services are crucial for maintaining good health and preventing serious illnesses.

According to a report by the Kaiser Family Foundation, the use of preventive services among people with private insurance coverage has increased significantly since the ACA’s implementation. The report found that in 2018, 71% of adults aged 18-64 with private insurance coverage received at least one preventive service.

The provision of free preventive services under the ACA has also helped to reduce healthcare costs in the long run. By catching diseases early and preventing them from developing into more serious conditions, individuals can avoid costly medical treatments and hospitalizations.

It’s important to note that the ACA provisions on preventive services only apply to in-network services. Out-of-network services may not be covered, and cost-sharing may still apply for non-preventive services. Additionally, the ACA’s future is uncertain, and there have been attempts to repeal or replace it in recent years.

The ACA’s coverage of preventive services at no cost-sharing has been a significant benefit for individuals with private health insurance coverage. It has increased the use of preventive services, reduced healthcare costs, and helped to promote overall health and well-being.

Agility agents, are you ACA certified yet? Learn more here!

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What to Know About Extended Medicaid Coverage for Mothers

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Health insurance agents, we have some great news to share with you that can benefit your clients. Several states have extended their Medicaid coverage program for postpartum care, allowing new mothers to access crucial healthcare services after giving birth.

As you know, the Affordable Care Act (ACA) provides states with the option to expand their Medicaid coverage for new mothers up to a year after childbirth, instead of the usual 60-day limit. Currently, 17 states (plus Washington, D.C.) have implemented the expansion program, and more states are expected to follow suit in the near future.

As an agent, it’s important to be aware of the expanding postpartum Medicaid coverage program and inform your clients of this option. Many new mothers may not be aware of this extension and could miss out on the opportunity to receive necessary medical attention during the first year of their child’s life.

Under the extension program, new mothers have access to services such as routine check-ups, mental health support, and family planning services. This can make a significant difference in their postpartum healthcare journey and ultimately lead to better health outcomes for both mother and child.

If you have clients who are new mothers or expecting, be sure to inform them of the postpartum coverage extension and encourage them to take advantage of it. If you’re not sure if your state has implemented the program, check with your local Medicaid office or healthcare provider to find out.

By staying informed and educating your clients on the expanding postpartum Medicaid coverage program, you can help improve their access to healthcare services and ensure they receive the best possible care during this important time in their lives.

Are you familiar with Medicaid Unwinding?

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What are 1095 forms for healthcare?

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The 1095 forms are tax documents used to report health insurance information to the Internal Revenue Service (IRS). They are part of the Affordable Care Act (ACA) and are used to determine eligibility for government subsidies and tax credits. 1095 forms are typically issued by employers, health insurance providers, and the Health Insurance Marketplace.

What is Form 1095-A

Form 1095-A is used to report health care coverage provided by the Health Insurance Marketplace. This form is sent to individuals who had a qualified health plan through the Marketplace during the year. It includes information about the insurance and the amount of any Advance Premium Tax Credit that was applied.

What is Form 1095-B

Form 1095-B is used to report health insurance provided by a health insurance company, such as an employer-sponsored plan. It includes information about the insurance and the names of the individuals covered.

What is Form 1095-C

Form 1095-C is used to report health insurance provided by an employer with 50 or more full-time employees. It includes information about the insurance and the names of the individuals covered.

Form 1095-C is also used by employers with 50 or more full-time employees to report the health insurance they offer their employees. It includes information about the coverage and the names of the individuals covered.

What is Form 1095-S and 1095-H?

Form 1095-H is used to report health insurance provided to individuals by the Department of Health and Human Services. It includes information about the coverage and the individuals covered.

Form 1095-S is used to report health insurance provided to individuals by a self-funded health plan. It includes information about the coverage and the names of the individuals covered.

Form 1095-S is used to report insurance coverage provided to individuals by a self-funded health plan. It includes information about the coverage and the names of the individuals

These forms are used to verify that individuals had health insurance during the tax year, and are used to determine eligibility for government subsidies and tax credits.They are also used to calculate the amount of the tax penalty for not having health insurance. It is important to keep these forms for your records, as they may be needed for tax returns and other financial matters.

In conclusion, 1095 forms are used to report health insurance information to the IRS and are used to determine eligibility for government subsidies and tax credits. They are issued by employers, health insurance providers, and the Health Insurance Marketplace. It is important to keep these forms for your records, as they may be needed for tax returns and other financial matters.

Why Agility?

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The IRS just made a final ruling regarding the “Family Glitch”

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The IRS just made a final ruling regarding the ACA “Family Glitch”. Here’s everything you need to know about it as a health insurance agent, and what this will mean for your customers.

The Final Rule addresses the “family glitch” in the Affordable Care Act by basing the affordability of employer-sponsored coverage for a family member on the cost of family coverage, rather than self-only coverage. 

This means that some dependents who have or have eligibility for a premium tax credit or for group health plan coverage may now be eligible for premium tax credits to purchase a subsidized Marketplace plan and may switch their coverage as a result, if permitted by plan rules. 

Starting in 2023, family members who currently do not meet the qualifications for premium tax credits may become eligible when purchasing health insurance through the Health Insurance Marketplace. This change does not affect the employer mandate penalty. 

Producers can help members who may be newly eligible for premium tax credits or refer them to another health insurance agent/broker qualified to sell health insurance plans through the Marketplace for more assistance. 

Group producers who want to help members get individual coverage must meet certain requirements, including registration, training completion, and agreement signing. 


Are you contracted yet to enroll your consumers in ACA health insurance plans?

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ACA Privacy and Security Requirements for Agents

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Agility Agents, now you can find a comprehensive Q&A for all your questions regarding ACA Privacy and Security Requirements! This Q&A answers everything you need to know as an agent with questions regarding ACA, and all the ACA requirements for agents such as yourself.

This Q&A includes information on consumer applications, national producer numbers, requirements for enrolling clients in marketplace coverage, security and compliance, and so much more! So be sure to read through for everything you need to know as an agent about ACA security requirements!

Check out the Q&A list here…

If you have any further questions or topics you want to explore as an Agility Agent, start exploring Enroll Insurance to learn more!

Agility Producer Support
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Ambetter Delay of Provider Service

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Notice of Temporary Delay: Provider Services

Date: 12/10/21

Ambetter from Superior HealthPlan’s Provider Services team is currently experiencing longer than normal wait times. While we work to rectify this issue and improve your experience, we encourage you to use the Secure Provider Portal for your business needs. These include, but are not limited to:

  • Verifying eligibility
  • Checking claims status
  • Viewing member benefits
  • Updating provider demographic information

Get contracted with Ambetter through Agility Insurance Services Now! 

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Top Reasons To Sell Ambetter

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Top Reasons To Sell Ambetter

1. We’re the number one carrier in the nation for the past 4 years.

– We’ve been here since the Marketplace opened, offering healthcare products in Illinois since 2015.


2. Affordable Health Plans

– Ambetter is projected to have one of the lowest cost Silver plans available on the Marketplace for 2022.


3. Across the nation, Ambetter covers in 1 in 6 lives on the Health Insurance Marketplace.

– Ambetter provides affordable coverage with valuable programs and services.


4. Enhanced Tele-Doc Program with a $0 copay.

– At home, in the office or even on vacation. Get medical advice, a diagnosis or a prescription for a non-emergency health issues when you need it.


5. My Health Pays

– Members can earn up to $500 in rewards annually. Rewards can be used to help pay for healthcare-related costs like monthly premium payments, reducing their monthly premium by up to $41 a month.


6. Value-added Benefits

– Start Smart for your Baby

– Health Management Programs

– 24/7 Nurse Advice Line

– Care Management


7. Enhanced Ambetter Broker Portal

– The Ambetter Broker Portal puts open enrollment at your fingertips. Use our self-service sales tools for insight into member policies and ways to better manage your Ambetter business.


8. Dedicate Broker Support Team

– Our team is available to answer questions on a wide range of topics including Ambetter plan information, commissions and broker web tools.


9. Free Enhanced Direct Enrollment Tool

– The entire enrollment process right from your dashboard! Call your Sales Rep. for details.


10. Centene ranks No. 25 in Fortune 500 list.

– We’re a diversified, multi-national company, transforming the health of the community, one person at a time.

Ambetter is America’s #1 Marketplace Health Insurance* – and we’re still growing. Ambetter is expanding into 5 new states for 2022.

 

Ambetter coverage gives clients more. From $0 Telehealth Services to our My Health Pays® Rewards Program, Ambetter has the valuable benefits your clients are looking for most in a health insurance plan.

Click the Links to View PDFs: The Top Reasons to Sell by State: Arkansas, Arizona, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Michigan, Missouri, Mississippi, New Hampshire, Nebraska, New Jersey, New Mexico, Nevada, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas and Washington.

Click here to get contracted with Ambetter. 


Agility Producer Support
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CVS-Aetna Branded ACA Plans To Target Eight States in 2022

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CVS-Aetna Branded Obamacare Plans Target 8 States For 2022 Launch

CVS Health is looking to sell individual coverage with the “CVS-Aetna” brand on exchanges under the Affordable Care Act in up to eight states for 2022.

Citing better market conditions and quality low priced health plans it can offer. CVS Health’s Aetna health insurance unit left the ACA’s exchanges four years ago under prior Aetna management along with other insurers that were unable to manage rising costs of uninsured patients signing up for such coverage.

CVS explained the company is just now working with insurance regulators and submitting plans and rates to offer individual coverage under the ACA, which is also known as Obamacare after President Obama. CVS isn’t yet disclosing the states it plans to offer these plans, executives confirmed Tuesday.

The CVS-Aetna move back into the ACA individual business comes under a more supportive White House under President Joe Biden, who was Obama’s vice president when the ACA became law.

Health insurers are already seeing a spike of new individual Obamacare subscribers thanks to new regulations and support to the companies and Americans looking for coverage from the Biden administration. That contrasts with the Donald Trump administration, which attempted to get Congress to repeal the ACA.

CVS sees a large market of Americans that have no coverage and the opportunity to offer a unique product given the company’s network of pharmacies, MinuteClinics, and hundreds of HealthHub store formats.


Here’s what the law means for you: 

  • Almost everyone is required to have health insurance. 
  • Nobody can be denied health insurance coverage. 
  • Most health plans must include preventative care at no cost to you. 
  • For most health plans, your out-of-pocket costs for healthcare can’t exceed a set amount. 
  • You must get a clearly written summary of your benefits and coverage. 
  • Children can stay on the family health plan until they turn 26. 
  • You can buy a health plan through a public exchange, or marketplace. Or you can buy a health plan without going through the public exchange. These plans must cover a defined set of benefits. 
  • If you buy your plan through a public exchange, the government may help you pay for it. 

The law covers most health plans sold today, but some parts don’t apply to plans that were sold before the law was passed.

Visit the Aetna website and Forbes for more information. 
 
 
Get contracted and ready to sell Aetna CVS Health plans for 2022! 

Agility Producer Support
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Aetna & CVS Health to enter the Affordable Care Act (ACA) Marketplace in 2022

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Aetna, CVS Health to enter the Affordable Care Act (ACA) individual insurance marketplace in Texas for January 1, 2022

This combines the health coverage of Aetna®, a CVS Health company, with local care at CVS Pharmacy®, MinuteClinic® and CVS® HealthHUB™ locations to deliver a quality, affordable health care experience.

 

WOONSOCKET, R.I., Aug. 4, 2021 /PRNewswire/ — Aetna and CVS Health (NYSE: CVS) will enter the individual insurance marketplace in Texas (specifically in select counties in the Austin, El Paso, Houston and San Antonio
markets) with the first Aetna CVS Health hybrid-branded insurance
product, providing access to health care for more Texans. Aetna and CVS
Health bring together quality along with convenience and expanded
services to meet consumer health needs, simply and affordably. 

“With the combined strength of Aetna and CVS Health, we’re uniquely
positioned to provide greater value for consumers, particularly the
millions of Americans who are uninsured or underinsured,” said Dan Finke,
Executive Vice President, CVS Health, President, Aetna. “We are taking a
human-centered approach to health care by connecting people to the
services and support they want – in their neighborhood, home and
virtually anywhere they need us.”

With these plans, members will have access to Aetna’s high-quality
network of health care providers and telemedicine services.
Additionally, the plan provides members with unique and convenient
health care offerings at MinuteClinic, HealthHUB and CVS Pharmacy
locations across the country.

Along with an enhanced direct enrollment experience via Aetna’s website, the plans feature:

  • No-cost or low-cost visits at any of the more than 50 MinuteClinic locations in Texas and over 1,100 MinuteClinic locations across the country.
  • Access to a Care Concierge at CVS HealthHUB locations, who is
    available to assist members by helping them navigate health care
    services and products.
  • 20% off select CVS Health Brand health and wellness products at any one of the 10,000 CVS Pharmacy stores. 
  • 90-day refills members can have delivered directly to their door for free.
  • Simplified member experience that lets members pay their premium at the store and manage their account with our mobile app or through the web.

“A key priority is providing people with access to the care they
need – simply, easily and affordably,” said Neela Montgomery, Executive
Vice President, CVS Health and President, CVS Pharmacy. “Whether it be
through our health plan, MinuteClinic, CVS HealthHUB, CVS Pharmacy or
any of our virtual care options, we are committed to helping simplify
health care and enable healthier outcomes.”

Additional CVS Health services include:

  • Added convenience with access to virtual care, including through MinuteClinic
  • Quality guidance and treatment for maternity care, as well conditions such as diabetes, hypertension, kidney disease
  • Help staying on track to better health with Pharmacy Advisor counseling and data-driven Next Best Actions or health nudges
  • Convenient, total health support with Destination Behavioral Health
  • Care in the comfort of the member’s home with Coram Home Infusion

The select Texas counties this new offering will be available in include Bexar, Brazoria, Comal, El Paso, Fort Bend, Galveston, Guadalupe, Harris, Hays, Kendall, Montgomery, Travis, and Williamson.

In addition to Texas, CVS Health is entering the individual exchange market in Arizona (Banner | Aetna), Florida, Georgia, Missouri, Nevada, North Carolina, Northern Virginia (Innovation Health) and Virginia.*

*Filings in each state are complete. Final approval to entry is pending state and federal reviews/certifications. 

About CVS Health

CVS
Health is the leading health solutions company, delivering care in ways
no one else can. We reach more people and improve the health of
communities across America through our local presence, digital channels
and our nearly 300,000 dedicated colleagues – including more than 40,000
physicians, pharmacists, nurses, and nurse practitioners. Wherever and
whenever people need us, we help them with their health – whether that’s
managing chronic diseases, staying compliant with their medications, or
accessing affordable health and wellness services in the most
convenient ways. We help people navigate the health care system – and
their personal health care – by improving access, lowering costs and
being a trusted partner for every meaningful moment of health. And we do
it all with heart, each and every day. Learn more at www.cvshealth.com.

About Aetna

Aetna,
a CVS Health business, serves an estimated 34 million people with
information and resources to help them make better informed decisions
about their health care. Aetna offers a broad range of traditional,
voluntary and consumer-directed health insurance products and related
services, including medical, pharmacy, dental and behavioral health
plans, and medical management capabilities, Medicaid health care
management services, workers’ compensation administrative services and
health information technology products and services. Aetna’s customers
include employer groups, individuals, college students, part-time and
hourly workers, health plans, health care providers, governmental units,
government-sponsored plans, labor groups and expatriates. For more
information, visit www.aetna.com and explore how Aetna is helping to build a healthier world.

 

ACA Contracting Available Here > 

 

News provided by


Aetna


Aug 04, 2021, 08:30 ET

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