)Ĭlaxton, Gary Cox, Cynthia Damico, Anthony Levitt, Larry Pollitz, Karen. This is a Catch-22 that state regulators must keep in mind when designing reinsurance programs. (Although in some cases, reinsurance programs can result in higher after-subsidy premiums for people who do get subsidies, as the reduction in subsidy amounts sometimes exceeds the reduction in overall average premiums. These decreases apply to full-price premiums, so they make coverage more affordable for people who don't get premium subsidies. In most cases, states that have created reinsurance programs have seen premium decreases as a result. Seventeen states have already established reinsurance programs, which have helped to stabilize their individual/family markets. States can seek 1332 waivers to receive federal funding to implement reinsurance programs or other innovative approaches to keeping premiums under control.By preventing healthy people from circumventing the ACA-compliant market in favor of plans that don't comply with the ACA's regulations, states help to ensure that their ACA-compliant markets continue to have a good mix of healthy people, who serve to keep the risk pool stable.

Nearly two-thirds of the states have restrictions on short-term plans that are more strict than the federal rules. States can enact regulations and legislation to prevent widespread access to longer short-term plans and association health plans.States can offer state-funded premium subsidies, either in addition to the federal ACA subsidies, or to populations that don't qualify for ACA subsidies.States can impose their own individual mandate (DC, Massachusetts, California, New Jersey, and Rhode Island have done so).Outside of that window, people normally cannot purchase coverage in the individual market unless they're eligible for a special enrollment period. Since coverage in the individual market cannot simply be purchased at any time a person chooses, it makes it harder for people to go without coverage and then be able to buy coverage if and when they need medical care. The annual open enrollment window is currently November 1 to January 15 in nearly every state. An annual open enrollment window during which people can enroll in individual market coverage (through the Marketplace/exchange, or directly through an insurer).The federal penalty for non-compliance was eliminated as of 2019. But New Jersey, Massachusetts, Rhode Island, California, and Washington DC have their own individual mandates and associated penalties for non-compliance. An individual mandate that requires almost all Americans to have health insurance or pay a penalty.Premium subsidies are designed to keep the after-subsidy cost of coverage at a specified percentage of income that's considered affordable. For those five years, a household with income above 400% of the poverty level can qualify for a premium subsidy if the cost of the benchmark plan would otherwise be more than 8.5% of the household's income. And for 2021 through 2025, the American Rescue Plan and Inflation Reduction Act have removed the upper income limit for subsidy eligibility. Premium subsidies for people earning up to 400% of the poverty level.

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