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More than the Marketplace: How Medicaid’s unwinding affects Medicare Supplement
The state of Michigan’s Department of Insurance and Financial Services (DIFS) clarified rules on transitioning from Medicaid to Medicare for those...
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Action Benefits Apr 17, 2024
Michigan's Department of Insurance and Financial Services releases an annual bulletin asking carriers to submit their forms and rates for on-Marketplace and off-Marketplace plans. While the bulletin doesn't cover all rules and regulations (CMS's Notice of Benefit and Payment Parameters is a better source), it provides insight into the state's priorities for the upcoming plan year. So, what's important to the state? And how will it affect health insurance agents?
Carriers can only offer two non-standard plans per network and metal level, unless they qualify for an exception. There won't be standardized options for non-expanded bronze plans, and all standardized plans will include some preventive drugs with zero cost share in Tier One.
CMS allows carriers to exceed the plan limit if they can show their benefit design treats chronic and/or high-cost conditions at 25% less cost-sharing than other non-standard plans. Prescription drug costs are included in this calculation, so carriers may target chronic conditions by re-shuffling high-cost drugs into lower tiers.
13 new specialties will be added to DIFS' network adequacy guidelines. A full list can be found in the bulletin. The state will ensure sufficient numbers of specialists like anesthesiologists, optometrists, dental oral, and maxillofacial surgeons, and certified nurse midwives are in-network before allowing carriers to operate in those areas. Some carriers may need additional specialists to begin or continue offering plans in a given county.
Deadlines are approaching – May 15 for small-group ACA plans and May 29 for individual issuers. Plans, DIFS, and CMS will exchange data over the next several months to ensure compliance. By October 2, CMS will finalize agreements with compliant issuers, just in time for Open Enrollment on November 1.
DIFS seems intent on building its vision of a more consumer-friendly market by limiting plan choices, allowing exceptions for plans targeting chronic conditions, and beefing up network adequacy standards. Whether these moves will produce the desired outcome remains to be seen.
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The state of Michigan’s Department of Insurance and Financial Services (DIFS) clarified rules on transitioning from Medicaid to Medicare for those...
2 min read
Official estimates report nearly 25% of Michigan’s population is receiving Medicaid or CHIP benefits. The recently passed federal budget legislation...
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An agent’s guide to Michigan’s Medicaid unwinding resources Good news for Michiganders: According to Georgetown University[i], we’re one of 10...