President-Elect Joe Biden has a new health insurance plan for America once he is inaugurated as President on January 20th.  He plans to build on the existing Affordable Care Act as opposed to creating an entirely new plan.  Below is a synopsis of The Biden Plan to Protect and Build on The Affordable Care Act.

  • Expand eligibility for tax credits for more than 400% of poverty level (current limit)
  • Calculate tax credits based on Gold Plans (currently based on Silver)
  • Capping premiums at 8.5% of family income (currently 9.86%)
  • If a family is covered by an employer plan but the individual marketplace plan would be less (due to the 8.5% cap), they can purchase marketplace coverage
  • Keep preexisting condition coverage
  • Proposed new public option (individuals who would qualify for Medicaid if their state had expanded could buy into this)
  • States that did expand Medicaid could move eligible citizens to the public option if they continued to pay their share of the cost to cover these individuals
  • Individuals below 138% of FPL would be automatically enrolled in the public option through interaction with certain institutions (i.e., public schools or SNAP)
  • Lower Medicare eligibility to 60
  • Supports a bill passed by the House last year to allow Medicare to negotiate drug prices with pharmaceutical companies same as private insurers
  • Prohibit new drug price increases beyond inflation and capping OOP drug costs for Medicare Part D
  • Limiting launch prices for drugs with no competition and limiting price increases of very expensive U.S. brand and biotech drugs to the prices reflected by inflation
  • Ban “surprise medical billing” when patient does not control the providers they see (i.e., during hospitalization)
  • Allow consumers to purchase prescription drugs from other countries, as long as HHS has certified them safe
  • Eliminate tax deduction for advertising for pharma companies
  • Double federal investment in Community Health Centers

Horman Mathematical & Actuarial Solutions, Inc. can assist you in all of your regulatory compliance and actuarial health care consulting needs, from understanding how regulatory changes affect your organization to rate review, reserving, and actuarial accruals.  Please contact us today to learn how HMA Solutions can help you.