ACA Insurance Coverage Up, Uninsured Rate Down: What This Means for Practices

ACA plansBy Bill Bunker, Executive Vice President, SCI Solutions

The Centers of Medicare and Medicaid Services (CMS) recently released a new report that shows nearly one million Americans shopped for health insurance and picked a plan on the federally-run Affordable Care Act (ACA) exchanges since the regular sign-up season ended. The 2015 enrollment period concluded in February but consumers who experienced a qualifying major life event, such as getting married or having a baby, could still sign up after that. Other events include losing healthcare coverage or Medicaid eligibility.

CMS officials state that 50 percent of the new plan selections were due to people losing existing plans. In addition, 47 percent of plans were selected by Americans 34-years-old and younger, a key demographic CMS has targeted because younger, healthier people drive down overall premium costs. Officials predict that of those who select a plan, 80-90 percent will eventually buy it.

Tax Deadline Mandate Spiked ACA Sign-Ups

In related news, new enrollment data from CMS shows a spike in ACA sign-ups before the health law’s April 30th individual mandate deadline. Analysts say the rising mandate penalty is having the desired effect to encourage Americans to sign up. In 2014, the penalty was $95 or one percent of income. In 2015, the penalty was $325 or 2 percent of income. The 2016 penalty is set at $695 or 2.5 percent of income. This year, over 38,000 Americans enrolled on April 30th alone – the biggest sign-up day since regular enrollment ended in February. Analysts hope the increasing penalty will encourage the remaining uninsured Americans to sign up prior to the 2016 deadline.

Uninsured Rate Declined by One-Third

Overall, the uninsured rate has declined by 15 million since 2013 when the ACA’s coverage expansion took effect according to a new report from the Centers of Disease Control and Prevention (CDC). The report found the number of uninsured Americans decreased from 44.8 million in 2013 to 29 million in the first quarter of 2015. The biggest coverage gains were made among low-income and Latino populations.  The report also notes the percentage of children with private coverage increased from 53.6 percent in 2013 to 56.3 percent in the first quarter of 2015, reversing a 14-year trend of declining rates of private coverage.

What This Means for Practices

So how does this affect practices, hospitals, and health systems? More insurance coverage means a higher likelihood that providers will be paid for their services, resulting in lower write-offs. In order to get paid however, practice staff must have their patient’s most current insurance plan information to avoid any reimbursement surprises.  Many ACA plans are dependent on the individual’s income bracket, so if their income varies month-to-month their insurance plan could be churning month-to-month as well. Practice staff should verify patient’s eligibility, network status, benefits, and obtain insurance authorizations as needed prior to providing services to ensure payment for their practice and avoid out-of-pocket expenses for their patients.

To do this efficiently, some practices rely on third-party services to stay up-to-date on payer changes so needed authorization information is obtained accurately and quickly. In a recent survey by Clarity Health, 77.5 percent of customers stated the ACA increased the complexity of obtaining authorizations and 80 percent stated the ACA increased time spent obtaining authorizations due to the expansion of payer and plan rules.

Has your practice experienced a higher percentage of insured patients due to the ACA? In relation, is your staff spending more time keeping up with payer rules to obtain accurate authorizations? Comment below.

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