The Current State Of ObamaCare - ACA

[sman]

April 30, 2016 Can health insurers still rescind a policy when they learn that a "non-smoker" customer actually smokes? HC.gov officials say that only 7% of applicants say they are smokers. Across the U.S. population 17% of adults are smokers. In some states, the gap between reported and actual, is ever wider. Full Story: Smokers are Cheating ObamaCare

Before ACA went live I was at a carrier meeting and someone asked how the carrier would know whether a person smoked or not. The answer..."we wouldn't know".

 

[kgmom219]

Before ACA went live I was at a carrier meeting and someone asked how the carrier would know whether a person smoked or not. The answer..."we wouldn't know".

Pre ACA, the way they would find out is via claims. There were certain procedure/diagnosis codes that triggered an audit. They would pull your medical records. And few people lie to the doctor.

And the only reason I found this out is because I had 2 clients, "roommates", who both had their policies rescinded for lying about tobacco usage.

 

[sman]

Pre ACA, the way they would find out is via claims. There were certain procedure/diagnosis codes that triggered an audit. They would pull your medical records. And few people lie to the doctor. And the only reason I found this out is because I had 2 clients, "roommates", who both had their policies rescinded for lying about tobacco usage.

I was speaking specifically of a meeting about ACA. One of those just a couple of months prior to the ACA roll out.

 

[kgmom219]

I was speaking specifically of a meeting about ACA. One of those just a couple of months prior to the ACA roll out.

I wasnt really trying to argue, but the logic is the same. You "forget" to click the smoker box (which is screwed up anyway, since I write Texans who dip) they can still get the diagnosis codes via claims.

 

[HealthRisk]

I wasnt really trying to argue, but the logic is the same. You "forget" to click the smoker box (which is screwed up anyway, since I write Texans who dip) they can still get the diagnosis codes via claims.

The wacky definition of tobacco use sort of throws claims out the window. Who cares if you smoked for 30 years and quit 1 year ago. You still get the non-smoker rate.

 

[Yagents]

When anyone does a life change, the system doesn't allow you to re-select tobacco usage, and defaults to non smoker many times.
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decent article:

​Which insurer will be next to abandon Obamacare? - CBS News

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New features on HC.gov for 17':

New programs compare standarized exchange plans based on price, quality - FierceHealthPayer

 

[TN_agent]

That explains a recent issue I had with the marketplace. It must have defaulted to nonsmoker when a smoker changed income, then been corrected but that has not been communicated to the carrier. Thanks for that tidbit.

 

[AllenChicago]

Friday May 6, 2016

S.E.P. rules tightened up a little bit more today...

"While these qualifying events existed before, the CMS is restricting how they are used. For example, individuals attempting to gain coverage through a special enrollment due to moving to a new home must have ACA-compliant coverage for one or more days in the 60 days preceding the move."

-and-

CMS will now allow ACA Co-ops to raise money...

"With Friday's interim final rule, co-ops will be able to "enter into strategic financial transactions with other entities" as a way to bolster their fledgling reserves, the CMS said. The agency added that because many of the remaining 11 co-ops are in perilous financial shape, "we believe that these changes are needed as soon as possible.""

SOURCE: http://www.modernhealthcare.com/article/20160506/NEWS/160509925

 

[RayNY]

"With Friday's interim final rule, co-ops will be able to "enter into strategic financial transactions with other entities" as a way to bolster their fledgling reserves, the CMS said.

I wonder how many investors want to throw their money into a sinking ship?

Anyone who knows anything about co-ops knows that the whole concept is flawed. There are no winners in the industry, just players that haven't lost yet.

 

[Yagents]

And then..........................there were 6

from same article:

The CMS acknowledged Friday that more could be done to ensure people were using special enrollment appropriately. Going forward, there will only be six circumstances in which a person can buy coverage outside of open enrollment: losing other health coverage, changes in household size due to marriage or birth, moving to a new home, changes in eligibility for financial help, errors made by marketplaces or plans, and cases of cycling between Medicaid and the marketplace or leaving Americorps coverage, according to the CMS.