4 ms·

Not all plans fall under this regulation.

lotsofpulp 3y ago
Any plan worth having does. If you are offered non ACA compliant health insurance, you should value it at $0, especially since there is no penalty for not having health insurance.
- ecommerceguy 3y ago
  Incorrect, I know of several TPA's that offer Qualified ACA plans that operate below 80% MLR. I can provide proof for my statement, can you do the same?
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  - lotsofpulp 3y ago
    What is a TPA? You are always welcome, even encouraged, to provide proof. I am getting my information from: https://www.healthcare.gov/health-care-law-protections/rate-review/ https://www.healthcare.gov/health-care-law-protections/rate-... >Does this apply to my plan? >It depends. >For Rate Review: These requirements don’t apply to grandfathered plans. Check your plan’s materials or ask your employer or your benefits administrator to find out if your health plan is grandfathered. >For the 80/20 Rule: These rights apply to all individual, small group, and large group health plans, whether your plan is grandfathered or not. I assume grandfathered plans are not ACA compliant, and hence do not have all the provisions that make health insurance worth having (such as out of pocket maximums and zero cost preventative care and appeals processes and other things that set a floor on the quality of healthcare covered by the insurance).
    - ecommerceguy 3y ago
      >>What is a TPA? Third Party Administrator. >>I assume grandfathered plans are not ACA compliant, Correct. >>hence do not have all the provisions that make health insurance worth having Not necessarily. Some have broader benefits that maybe you would want. https://www.healthcare.gov/health-care-law-protections/rate-review/ https://www.healthcare.gov/health-care-law-protections/rate-... Some states are 85/15. Did you know that? However, the plans you are referring to are Marketplace plans. I am not referring to Marketplace plans, nor community rated employer plans. I'm referring to self funded employer based commercial plans. These same type of plans are commonly offered not only in the US, but UK, Canada and Germany. Edit: I get downvoted for providing proof.
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chimeracoder 3y ago
> Not all plans fall under this regulation. No, but it's a small number. Approximately 13% of people with employer-provided plans have grandfathered plans[0]. That number is also steadily decreasing over time. That's specifically looking at people who get their insurance through their own employer, so the denominator doesn't include, for example, people on Medicare or Medicaid. The 80% claims rule doesn't apply to every individual plan, but it's widespread enough that it drives the overall structure of how insurance companies operate these days. They're not optimizing their organizational workflow for plans which comprise a tiny - and shrinking - fraction of their revenue. [0] https://www.kff.org/report-section/ehbs-2019-section-13-grandfathered-health-plans/ https://www.kff.org/report-section/ehbs-2019-section-13-gran...
paulddraper 3y ago
Not technically, but practically.

Any plan worth having does. If you are offered non ACA compliant health insurance, you should value it at $0, especially since there is no penalty for not having health insurance.

ecommerceguy 3y ago
Incorrect, I know of several TPA's that offer Qualified ACA plans that operate below 80% MLR. I can provide proof for my statement, can you do the same?
- deleted 3y ago
  [deleted]
- deleted 3y ago
  [deleted]
- lotsofpulp 3y ago
  What is a TPA? You are always welcome, even encouraged, to provide proof. I am getting my information from: https://www.healthcare.gov/health-care-law-protections/rate-review/ https://www.healthcare.gov/health-care-law-protections/rate-... >Does this apply to my plan? >It depends. >For Rate Review: These requirements don’t apply to grandfathered plans. Check your plan’s materials or ask your employer or your benefits administrator to find out if your health plan is grandfathered. >For the 80/20 Rule: These rights apply to all individual, small group, and large group health plans, whether your plan is grandfathered or not. I assume grandfathered plans are not ACA compliant, and hence do not have all the provisions that make health insurance worth having (such as out of pocket maximums and zero cost preventative care and appeals processes and other things that set a floor on the quality of healthcare covered by the insurance).
  - ecommerceguy 3y ago
    >>What is a TPA? Third Party Administrator. >>I assume grandfathered plans are not ACA compliant, Correct. >>hence do not have all the provisions that make health insurance worth having Not necessarily. Some have broader benefits that maybe you would want. https://www.healthcare.gov/health-care-law-protections/rate-review/ https://www.healthcare.gov/health-care-law-protections/rate-... Some states are 85/15. Did you know that? However, the plans you are referring to are Marketplace plans. I am not referring to Marketplace plans, nor community rated employer plans. I'm referring to self funded employer based commercial plans. These same type of plans are commonly offered not only in the US, but UK, Canada and Germany. Edit: I get downvoted for providing proof.
- deleted 3y ago
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chimeracoder 3y ago

> Not all plans fall under this regulation. No, but it's a small number. Approximately 13% of people with employer-provided plans have grandfathered plans[0]. That number is also steadily decreasing over time. That's specifically looking at people who get their insurance through their own employer, so the denominator doesn't include, for example, people on Medicare or Medicaid. The 80% claims rule doesn't apply to every individual plan, but it's widespread enough that it drives the overall structure of how insurance companies operate these days. They're not optimizing their organizational workflow for plans which comprise a tiny - and shrinking - fraction of their revenue. [0] https://www.kff.org/report-section/ehbs-2019-section-13-grandfathered-health-plans/ https://www.kff.org/report-section/ehbs-2019-section-13-gran...

paulddraper 3y ago

Not technically, but practically.