modified community rating

modified community rating

A pricing stratification for medical services which is based on data from a given geographic area.

modified community rating

Managed care A method of determining rates for medical services based on data from a given geographic area. See Service mix.
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Under both the Massachusetts reform and the ACA, prices are set in a modified community rating framework: prices can vary by only certain enrollee characteristics and only within certain ranges.
Moreover, because of modified community rating pricing regulations, premiums for different ages are linked.
In simulations in Ericson and Starc (2012b), we found that compared to unrestricted prices, modified community rating has the potential to improve outcomes for consumers in this market.
Supreme Court on the question before the court of whether to overturn a lower court ruling that the individual health insurance mandate included in the Affordable Care Act can be "severed" from the guaranteed issue and modified community rating provisions.
Severing the mandate from the guaranteed issue and modified community rating provisions would result in greater adverse selection, leading to lower participation and higher health insurance premiums," said Cori Uccello , the senior health fellow for the American Academy of Actuaries.
Co-ops in states with community rating laws (or modified community rating aimed at smaller businesses) find it even more difficult to achieve savings.
According to HB 1622, beginning July 1, 1995 the state would operate under a modified community rating system (some variations allowed) that would lead to phasing in a pure community rating system beginning January 1, 1999.
Retirees could stand to benefit from exchanges, where they can buy health Insurance, as well as other insurance-market reforms including guaranteed issue, modified community rating, and premium and costsharing subsidies for those under 400 percent of poverty, as well as increased health plan choices, Fronstin says.
Having called repeatedly for the General Assembly to modernize the laws that regulate our state's health insurance markets, SMC is greatly encouraged by the Governor's endorsement of the concept of modified community rating for small businesses - the concept that underlies health insurance rating laws in 48 other states.
Since 1994, health premiums for businesses of 50 employees or fewer have been set using a modified community rating, which guarantees coverage for small businesses and bases health premiums on demographic factors.
Modified community ratings which restrict carriers from charging consumers different rates based on factors like health status

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