Jeff Smedsrud's Health Insurance Development Watch List

What You Need to Know

Jeff Smedsrud helped start Healthcare.com.
He finds the proposed Medicare Advantage lead-generation rules interesting.
He is watching individual coverage health reimbursement arrangements closely.
He is not expecting major federal short-term medical insurance regulations to show up this year.

I’ve been setting up and running health insurance programs for decades. People often ask me to list the industry developments that interest me the most.

Here are six I’m watching now.

1. New CMS Marketing Regulations

Will new rules hurt those they intend to help?

The Biden administration is proposing new rules for Medicare Advantage intended to reduce confusion (and annoyance) for consumers who went to a lead-generation website to request information about Medicare plans.

Lead-generation websites are not affiliated with insurance carriers and ask consumers specific information about themselves when requesting quote information for one or more plans.

Sometimes those ‘leads’ are sold to marketers who might have licenses with multiple insurance companies, which can result in confusion for the consumer.

The new rules say that Medicare Advantage leads can only be provided to the carrier that offers the plan the consumer requests.

The problem is most consumers don’t know what plan they want, and thousands of brokers every day help them make informed decisions that improve their coverage and often save them money. While the issue of consumer confusion has been most acute in the Medicare Advantage market with a plethora of celebrity TV commercials (think Joe Namath and Jimmy Walker).

Concern about misrepresentation in the Affordable Care Act (ACA) market is starting to bubble to the surface as well.

Sometimes regulations are needed to protect consumers, but often the federal government over-reaches and creates new problems instead of solutions.

Brokers and advisors should voice their opinion about their role in helping improve health care choices for millions of consumers seeking options.

2. Faith-Based Health Plans

Not regulated, but are they helpful or harmful?

About 1 million Americans are enrolled in health care sharing ministries, which are also known as faith-based health plans. The plans look like and act like individual health insurance.

However, they are not regulated at the state or federal level.

Faith-based plans can deny coverage and place restrictions on whether a claim is paid (if it is ‘shared’ with the faith body that subscribes to the service) or denied.

The monthly cost of these plans is usually less than that of Affordable Care Act plans, but those enrolled are not eligible for ACA tax subsidies.

Question: Will there be attempts to regulate these plans in 2023?

My view: Yes, there should be a discussion.

But I favor the disrupters. If you look at the history of fraternal insurance plans and other insurers that helped consumers challenge the norms of an established industry, progress is always on the side of those who create a bit of chaos.

Certainly, some faith-based plans should undergo scrutiny, but that is as it should be for all companies.

We learn from change.

3. Individual Coverage Health Reimbursement Arrangements

Will this hard-to-pronounce solution for the individual health market finally become a relevant alternative, or will it continue to occupy only a tiny niche?

The individual coverage health reimbursement arrangement, or ICHRA, was created through regulations completed by the administration of former President Donald Trump. It has bipartisan support.

In an ICHRA, employers of any size can reimburse employees for some or all of the premiums that the employees pay for health insurance they purchase on their own.

Thus far, based on reports, there are more than 200,000 consumers enrolled in ICHRA arrangements. ICHRAs have penetrated less than 1% of the U.S. commercial health insurance market.

There are zealous proponents of this solution and equally strong opponents.

Pro tip: If a group — whether large or small — is being offered more than a 15% rate increase for their benefit plan, make an ICHRA plan one of the options you present.

4. Georgia on My Mind

Will proposed ACA reforms become law in a swing state?