Health insurance (21 - 30 of 664 items)
State Health Insurance Marketplaces: CMS Should Improve Oversight of State Information Technology Projects
GAO-15-527: Published: Sep 16, 2015. Publicly Released: Sep 16, 2015.
States reported to the Department of Health and Human Services' (HHS) Centers for Medicare & Medicaid Services (CMS) that they spent about $1.45 billion in federal marketplace grant funding on information technology (IT) projects supporting health insurance marketplaces, as of March 2015. The majority of this spending was for state-based marketplaces (i.e., marketplaces established and operated by...
Private Health Insurance: The Range of Premiums and Plan Availability for Individuals in 2014 and 2015
GAO-15-687: Published: Aug 10, 2015. Publicly Released: Sep 9, 2015.
As of 2014, key provisions of the Patient Protection and Affordable Care Act (PPACA) resulted in the establishment of health insurance exchanges in each state and changed how insurers determined health insurance premiums. Individual market consumers generally had access to more health plans in 2015 compared to 2014, and in both years the lowest-cost plans were available through exchanges in most o...
Patient Protection and Affordable Care Act: Observations on 18 Undercover Tests of Enrollment Controls for Health-Care Coverage and Consumer Subsidies Provided under the Act
GAO-15-702T: Published: Jul 16, 2015. Publicly Released: Jul 16, 2015.
To assess the enrollment controls of the federal Health Insurance Marketplace (Marketplace), GAO performed 18 undercover tests, 12 of which focused on phone or online applications. During these tests, the Marketplace approved subsidized coverage under the Patient Protection and Affordable Care Act (PPACA) for 11 of the 12 fictitious GAO applicants for 2014. The GAO applicants obtained a total of a...
Patient Protection and Affordable Care Act: Despite Some Delays, CMS Has Made Progress Implementing Programs to Limit Health Insurer Risk
GAO-15-447: Published: Apr 30, 2015. Publicly Released: Jun 1, 2015.
The Centers for Medicare & Medicaid Services (CMS) considered market characteristics and program duration in designing the three programs mandated by the Patient Protection and Affordable Care Act (PPACA) to mitigate the risks issuers of health insurance faced starting in 2014. Each of the three programs—risk adjustment, reinsurance, and risk corridors—was intended to account for a different s...
Private Health Insurance: Premiums and Enrollment for New Nonprofit Health Insurance Issuers Varied Significantly in 2014
GAO-15-304: Published: Apr 30, 2015. Publicly Released: Jun 1, 2015.
As of January 2015, the Centers for Medicare & Medicaid Services (CMS)—the agency that administers and monitors the consumer operated and oriented plan (CO-OP) program—has disbursed about two thirds of the $2.4 billion in loans awarded to 23 CO-OPs. CMS has disbursed about $351 million in start-up loans and $1.2 billion in solvency loans. The percentage of start-up loan funding disbursed to CO...
Children's Health Insurance Program: Effects on Coverage and Access, and Considerations for Extending Funding
GAO-15-348: Published: Feb 27, 2015. Publicly Released: Mar 30, 2015.
Assessments of national data GAO reviewed identify positive effects of the State Children's Health Insurance Program (CHIP), and the quality measures reported by states help identify areas needing improvement.A mandated evaluation of CHIP published in 2014 noted that CHIP enrollees (1) had substantially better access to care, service use, and preventive care when compared with uninsured children;...
Children's Health Insurance: Coverage of Services and Costs to Consumers in Selected CHIP and Private Health Plans in Five States
GAO-15-323: Published: Feb 25, 2015. Publicly Released: Mar 27, 2015.
In five selected states, GAO determined that coverage of services in the selected State Children's Health Insurance Program (CHIP) plans was generally comparable to that of the selected private qualified health plans (QHP), with some differences. In particular, the plans were generally comparable in that most covered the services GAO reviewed with the notable exceptions of pediatric dental and cer...
Medicare: Payment Methods for Certain Cancer Hospitals Should Be Revised to Promote Efficiency
GAO-15-199: Published: Feb 20, 2015. Publicly Released: Mar 23, 2015.
Unlike beneficiaries seen at teaching hospitals paid under Medicare's prospective payment systems (PPS) in 2012, nearly all beneficiaries seen at PPS-exempt cancer hospitals (PCH)—a group of 11 facilities having met certain statutory criteria—had a diagnosis of cancer. However, the health status of Medicare beneficiaries with cancer who were treated at PCHs and PPS teaching hospitals was not m...
Private Health Insurance: Early Evidence Finds Premium Tax Credit Likely Contributed to Expanded Coverage, but Some Lack Access to Affordable Plans
GAO-15-312: Published: Mar 23, 2015. Publicly Released: Mar 23, 2015.
Early evidence suggests that the advance premium tax credit (APTC)—the refundable tax credit that can be paid on an advance basis—likely contributed to an expansion of health insurance coverage in 2014 because it significantly reduced the cost of exchange plans' premiums for those eligible. Although there are limitations to measuring the effects of the APTC using currently available data, surv...
Healthcare.gov: CMS Has Taken Steps to Address Problems, but Needs to Further Implement Systems Development Best Practices
GAO-15-238: Published: Mar 4, 2015. Publicly Released: Mar 4, 2015.
Several problems with the initial development and deployment of Healthcare.gov and its supporting systems led to consumers encountering widespread performance issues when trying to create accounts and enroll in health plans:Inadequate capacity planning: The Centers for Medicare & Medicaid Services (CMS) did not plan for adequate capacity to support Healthcare.gov and its supporting systems.Softwar...