Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers/suppliers to revalidate their Medicare enrollment information under new enrollment screening criteria. CMS has completed its initial round of revalidations and will be resuming regular revalidation cycles in accordance with 42 CFR §424.515. In an effort to streamline the revalidation process and reduce provider/supplier burden, CMS has implemented several revalidation processing improvements one of which is established due dates by which you must revalidate.
The Affordable Care Act created the new Pre-Existing Condition Insurance Plan (PCIP) program to make health insurance available to Americans denied coverage by private insurance companies because of a pre-existing condition. Coverage for people living with such conditions as diabetes, asthma, cancer, and HIV/AIDS has often been priced out of the reach of most Americans who buy their own insurance, and this has resulted in a lack of coverage for millions. The temporary program covers a broad range of health benefits and is designed as a bridge for people with pre-existing conditions who cannot obtain health insurance coverage in today’s private insurance market. To learn more, visit PCIP.gov or HealthCare.gov.
Note: * Massachusetts and Vermont are guarantee issue states that have already implemented many of the broader market reforms included in the Affordable Care Act that take effect in 2014. Existing commercial plans offering guaranteed coverage at premiums comparable to PCIP are already available in both states.
Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers and suppliers to revalidate their enrollment information under new enrollment screening criteria. This revalidation effort applies to those providers and suppliers that were enrolled prior to March 25, 2011. Newly enrolled providers and suppliers that submitted their enrollment applications to CMS on or after March 25, 2011, are not impacted. Between now and March 23, 2015, MACs will send out notices on a regular basis to begin the revalidation process for each provider and supplier. Providers and suppliers must wait to submit the revalidation only after being asked by their MAC to do so. Please note that 42 CFR 424.515(d) provides CMS the authority to conduct these off-cycle revalidations.
All figures are based on plan selections with coverage periods that include March 1, 2015. A consumer's metal level corresponds to the policy that he or she selected. Metal levels include platinum, gold, silver, bronze, and catastrophic plans. Catastrophic plans have the lowest premiums, but the highest deductibles and other out-of-pocket expenses, while platinum have the highest premiums and lowest deductibles and out-of-pocket costs. All states allow the sale of gold, silver, and bronze plans but may not allow the sale of platinum and/or catastrophic plans. Additionally, catastrophic plans are generally only available to consumers younger than 30.
All figures are based on plan selections with coverage periods that include March 2016. Returning consumers had an active plan selection with 2015 coverage on or after 11/1/2015. Returning consumers were further classified into two sub-types: (i) those who were auto enrolled into the same or similar plan in 2016 and (ii) those who actively selected a new plan for coverage year 2016. Consumers were classified as new if they did not have an active plan selection in 2015 with coverage on or after 11/1/2015.
All figures are based on plan selections with coverage periods that include March 2016. A consumer's household income as a percent of the Federal Poverty Level (FPL) is documented when a consumer provides his or her household income; income is not a required field and may be missing on an application. Once the household income data is provided, along with the number of household members, the income level as a percent of the Federal Poverty Level is calculated. Guidelines for calculating FPL are set on a yearly basis by the U.S. Census Bureau.