February: Oscar is able to get young and healthy people on an expensive network and high risk adjustment payments. I can’t figure out their business model past the buzzwords. March: Oscar is incurring losses of roughly $145 Per Member Per Month (PMPM) in its biggest market. It is charging roughly $190 PMPM in net …
APTC Hacks, BHP and 1332 Waivers
The ACA has two non-Exchange means of significantly expanding and configuring coverage. The Basic Health Plan (BHP) allocated 95% of the combined funding of the Advanced Premium Tax Credit (APTC) and Cost-Sharing Reduction (CSR) subsidies of a state that would have been paid to cover people earning between 138% and 200% of the Federal Poverty …
APTC Hacks, Non subsidized plans and choice revelation
Advanced Premium Tax Credits (APTC) are only relevant for people who buy policies on the Exchanges. However the subsidized universe is only about half of the entire individual market. The non-subsidized and off-Exchange universes will help us determine how carriers embark on their Silver pricing strategies. If an individual would have qualified for an APTC …
APTC Hacks, Non subsidized plans and choice revelationPost + Comments (4)
Zika and abortions
Scientific America has some bad news about Zika in Puerto Rico: “Based on the limited available information on the risk of microcephaly, we estimate between 100 to 270 cases of microcephaly might occur” between mid-2016 and mid-2017, said Dr. Margaret Honein, chief of the birth defects branch at the CDC, who was one of several …
APTC Hacks — defining terms
Advanced Premium Tax Credits (APTC) are how people get subsidized to buy Qualified Health Plans (QHP) on Exchange. They are based on an individual’s income as determined by their family unit’s Federal Poverty Line (FPL) percentage and the cost of the second least expensive Silver plan offered on Exchange in their area. The subsidy arrangement …
A CAP in Illinois
“BCBS-IL won’t credit deductibles paid to failing insurance co-op” (Big issue for struggling #Healthcare consumers) https://t.co/jLvfy2aWK4 — Steve Sisko (@ShimCode) August 20, 2016 Going to be a mass adverse selection event for anyone that offers OOP credits https://t.co/iLmtt9dufm — Richard Mayhew (@bjdickmayhew) August 20, 2016 What is the situation and why am I thinking it …
Guest Post: End of Life Doulas
By: Prescott Cactus dou·la ˈdo͞olə noun plural noun: doulas a woman who is trained to assist another woman during childbirth and who may provide support to the family after the baby is born. The word “doula” comes from the ancient Greek meaning “a woman who serves” and is now used to refer to a trained …