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Home ACA Compliance Health Carriers Are Benefiting From The ACA

Health Carriers Are Benefiting From The ACA

3 minute read
by Robert Sheen

Several health carriers are experiencing growth because of the recent Affordable Care Act advancements. Most notably is CVS Health Corp. and its affiliated health insurance business, Aetna.

Last week the health carrier stated that it will be entering the ACA individual coverage marketplace in eight states, including Texas, Florida, Georgia, Missouri, Nevada, North Carolina, and Virginia.

Aetna and CVS Health will be offering a first-time “hybrid-branded insurance product” in the aforementioned locations effective January 1, 2022. 

The health plan will provide an enhanced experience for direct enrollment on Atena’s website. According to a press release, the plan in select locations will also feature “Access to a Care Concierge at CVS HealthHUB locations, who is available to assist members by helping them navigate health care services and products.” In addition,  members will have access to Aetna’s HMO network and receive up to 20% off select CVS wellness products. 

Executive Vice President, CVS Health, and Aetna President, Dan Finke said, “With the combined strength of Aetna and CVS Health, we’re uniquely positioned to provide greater value for consumers, particularly the millions of Americans who are uninsured or underinsured…We are taking a human-centered approach to health care by connecting people to the services and support they want – in their neighborhood, home and virtually anywhere they need us.”

Another healthcare insurer taking part in the ACA action is Cigna, which recently made public its second-quarter financial data. The company announced that its earnings increased nearly 25% since the same time last year. 

A big factor in why Cigna is experiencing such growth can be attributed to the healthcare provider’s participation in the ACA, offering of individual plans, and because of Biden’s special enrollment period, according to a post by Forbes.

The federal special enrollment period launched in February and has generated over 2 million additional enrollees through state and federal health exchanges. Individuals have until August 15 to sign up for ACA coverage through the extended enrollment period.

For the third year in a row, the number of health carriers entering the ACA marketplace has grown, according to data issued by the Kaiser Family Foundation. And judging by Aetna’s recent announcement and Cigna’s profits, the 2022 tax year may become the fourth.

Biden’s ACA advancements continue to create greater access to affordable coverage for Americans. A new proposed rule issued by the Centers for Medicare and Medicaid Services (CMS) seeks to expand the annual ACA open enrollment an additional 30 days, as well as create special enrollment opportunities for certain low-income individuals. 

Health insurance carriers continued ACA success further drives home the importance of bolstering the ACA. As part of the ACA, employers too must extend certain healthcare coverage to full-time employees as part of the law’s Employer Mandate.

Under the ACA’s Employer Mandate, Applicable Large Employers (ALEs) are employers with 50 or more full-time employees and full-time equivalent employees. ALEs are required to:

  • Offer Minimum Essential Coverage (MEC) to at least 95% of their full-time workforce (and their dependents) whereby such coverage meets Minimum Value (MV)
  • Ensure that the coverage is deemed affordable based on one of the IRS-approved methods for calculating affordability

Failure to adhere to these two requirements could subject your organization to Internal Revenue Code (IRC) Section 4980H penalties.

Employers should anticipate increased ACA enforcement from the IRS as advancements to the healthcare law continue. It’s worth noting even if you comply with the law but fail to report correctly, the agency may assess penalties. 

If you’re interested in finding out your ACA compliance score, contact us to find out for free.

For information on how your organization should approach ACA compliance, download the 2021 ACA Essential Guide for Employers.

We’re committed to helping companies reduce risk, avoid penalties, and achieve 100% ACA compliance. For questions about the ACA contact us here.

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