Robert Pear in the New York Times has an interesting piece today discussing the consequences of OPM’s decision to provide Members of Congress and their official staff members with a government contribution for health insurance exchange coverage beginning next year. As Mr. Pear points out, a defect in the law and related regulation is the expectation these all of these folks to receive exchange coverage. However the exchanges are designed and priced to cover people under age 65. This cadre no doubt includes many people over age 65. The ACA anticipates that people aged 65 and older will receive Medicare coverage. Time will tell.
Earlier this year, the ACA regulators created a transitional safe harbor for complying with the ACA’s new out-of-pocket maximums. The regulators are permitting plans that use a separate prescription manager, for example, to have separate out-of-pocket maximums for medical and prescription drug benefits. The consumer groups objected to the decision. Modern Healthcare reports that the ACA regulators have told the consumer groups to pound sand.
Modern Healthcare also is reporting that CMS is increasing pressure on health insurers to comply with the HIPAA 270 and 271 standard electronic transactions which are eligibility inquiries. Apparently there is a large insurer that is not cutting the mustard, as they say.
Finally voluntary.com has posted a Healthpocket.com list of the top 10 procedures not covered by health insurance. No big surprises in the list.