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

,

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!

Agility Producer Support
(866) 590-9771
support@enrollinsurance.com

/by

ACA Subsidy Extension

,

ACA Subsidy Extension

Your health insurance cost could be on the rise. Projections of “double-digit spikes” are said to begin early 2023 for over 13 millions Americans. Low and middle income Americans are at risk of losing health insurance due to the cost rising to hundreds of dollars per person if the extended subsidies end at the end of the year.

The American Rescue Plan Act (ARPA) increased the ACA (Affordable Care Act) subsidies in 2021 and 2022. The enhanced subsidies were said to lead towards over 4 million new sign-ups a year. This extension ensured that low-income clients did not have to pay for premiums. The enhancement in subsidies is said to end at the end of 2022 due over $247.9 billion in federal spending if it becomes permanent.

There has been debate for some time over the “economic spending legislation” but the Senate is proposing to keep the extension through 2025. For those who have been concerned about their extension for the enhanced subsidies, we have news for you. The bill proposed by the Senate is a part of a $300 billion package that will help lower drug costs overall as well.

The goal is to ensure Americans can afford healthcare while also reducing the cost in the deficit. A projected decline in other insurance sources such as employer-sponsored insurance will increase the need for over 600,000 Americans. Currently there is a 500,000 decrease for non-group coverage and 200,000 combined increase in those needing CHIP and Medicaid.

Due to the increased spend projected to $247.9 billion the senate is proposing a $300 billion package to help reduce the deficit and lower inflation rates. At this point 600,000 people no longer receive employer-sponsored insurance and the senate is striving for action to be made. We will keep you updated and informed on this and other news. Make sure to check our website and social media.

This is part of a much larger deal addressing health care, environmental relief, raising taxes on the wealthy and large companies, reducing the federal debt. We will keep you updated and informed on this and other news. Make sure to check our website and social media. 

You can read more details about the deal here!

Agility Producer Support
(866) 590-9771
support@enrollinsurance.com

/by

FAQs on Agent and Broker Compensation for Special Enrollment Periods

, , , ,

 

FAQs on Agent and Broker Compensation for Special Enrollment Periods

 

 

 

 

 

 

 

 

 

The Centers for Medicare & Medicaid Services (CMS) posted Frequently Asked Questions (FAQs) regarding compensation paid by issuers to agents and brokers who assist consumers with enrollment during a Special Enrollment Period (SEP) or during Open Enrollment Periods (OEPs). It has been made a priority by the Biden-Harris Administration to provide those who are uninsured and underinsured with quality, affordable health care coverage and recognizes that agents and brokers play a vital role in helping consumers enroll in coverage that best fits their needs and budget.

 

CMS has become aware that some issuers in the individual market, who commonly use agents and brokers as part of their marketing and sales distribution channels, have reduced or eliminated commissions and other forms of compensation to agents and brokers for enrollments during an SEP. Today’s FAQs provide guidance that paying differential compensation to agents and brokers for coverage in the same benefit year based on whether the enrollment is completed during an SEP or during the OEP is prohibited under federal law. These practices violate the guaranteed availability protections afforded to these individuals under the Affordable Care Act.

The Centers for Medicare & Medicaid Services (CMS) has become aware that some health insurance issuers offering individual market health insurance coverage, including issuers of qualified health plans offered through the Marketplaces, have reduced or eliminated commissions and other forms of compensation for agents and brokers who assist consumers with enrollments in individual market coverage during a special enrollment period (SEP). 

Is it permissible for an issuer to differentially compensate agents or brokers who assist consumers with enrollments in individual market coverage in the same benefit year based on whether the enrollment is completed during an SEP or during the applicable benefit year’s Open Enrollment period (OEP)? 

No. Arrangements that pay reduced or no commissions and other forms of compensation to agents and brokers who assist consumers with enrollment in individual market coverage during an SEP and pay higher amounts for OEP enrollments for the same benefit year violate the guaranteed availability provisions of the Affordable Care Act. Issuers’ normal conduits for receiving applications and offering coverage must also be open to individual market consumers for OEP and SEP enrollments, as applicable. An arrangement that reduces or eliminates the commission or other compensation an agent or broker receives for SEP enrollments compared to the commission or other compensation received for OEP enrollments in the same benefit year discourages agents and brokers from marketing to and enrolling individuals eligible for an SEP. These practices therefore violate the guaranteed issue protections afforded to these individuals under the statute. Exceptions may be made for cases in which state regulators make specific recommendations for issuers to address solvency concerns or financial capacity limitations.



Visit Agility Insurance Services to learn more about ACA contracting!

Agility Producer Support
(866) 590-9771
support@enrollinsurance.com

/by

Ambetter Delay of Provider Service

, , ,

 

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! 

Agility Producer Support
(866) 590-9771
support@enrollinsurance.com

/by

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

, , , , , , , ,

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

Agility Producer Support
(866) 590-9771
support@enrollinsurance.com

/by

New Google Certification for ACA (Affordable Care Act) Advertising

, , , , , , ,

Update to Healthcare Policy (June 2021):

Google has announced a new certification program for health insurance advertisers to
aid in curbing misinformation or fraud. This special certification will
be required for ACA health insurers or third-party brokers who want to
run Google Ads. Brokers will need to provide documentation showing they are permitted under state law to sell health insurance. 
 

 

Beginning May 3rd, 2021, brokers can apply for certification. Certification must be completed by June 2nd, 2021. If certification is not completed by June 2nd, Google will no longer be able to serve their ads.

 

You can Read Full Google Ad Policy Here >

Agility Producer Support
(866) 590-9771
support@enrollinsurance.com

/by