Moody's: HIX Uncertainties Will Hurt NP Hospitals' Credit
"The reality is none of us really know how it is going to shake out until we begin to get some data out of the various exchanges in terms of who is enrolling and what level plans they are enrolling in, etc…," she says.
"There are some other things that we have been looking at that we think are going to play a role too. For example, we think that some of the really heavy initial push to enroll will be for people who have pre-existing conditions. The Pre-existing Condition Insurance Program capped out and stopped enrolling people almost a year ago. So people with pre-existing conditions are likely to be some of the first in line here and people with pre-existing conditions use a lot of services."
Pryga says hospitals are also trying to figure out how insurance market rules that go into effect on Jan. 1 could affect providers' bottom lines.
"For example, one thing that goes away is the annual limits on the amount of benefits that get covered during the year. Another thing that happens is the implementation of out-of-pocket limits under all of those plans, not just in the exchanges but outside of the exchanges as well," she says.
"All of those plans, whether they are individual, small group, large group or self-insured are going to have out-of-pocket limits on cost sharing. So, the combination of the removal of the annual limits and the limits on out-of-pocket expenditures, while they differ for those groups, is going to be an effect."
- How Top-Ranked MA Plans Earn Their Stars
- WellPoint Dominates Nearly Half of Markets, AMA Says
- CMS Offers Some ACOs $114M for 'Upfront' Costs
- How Hospitals Can Become 'Upstreamists'
- Ebola: Second TX Nurse Diagnosed After Improper Protective Gear Application
- Providers Ask HHS to Address EHR Interoperability Barriers
- 16 Medicare Advantage Plans Earn 5-Star Ratings
- The Drug Price Reform Debate
- 5 Digital Marketing Efforts Every Hospital Should Try
- CMS' new investment model will help ACOs with health IT