Learning from Medicare Advantage and Part D: Lessons for the individual insurance market under ACA

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By Hans K. Leida | 15 August 2013
Commercial issuers of non-grandfathered individual insurance plans face new challenges under the Patient Protection and Affordable Care Act (ACA)—especially if they plan to provide those plans through state health exchanges as qualified health plans (QHPs). This exploration highlights the lessons that individual insurers can learn from Medicare Advantage and Medicare Part D (MAPD) that will help them reduce risk and plan for the future. This paper compares MAPD and the individual market under the ACA, describes plan design, rating restrictions, and new regulatory oversights, and sets forth a basis for optimism in the face of broad changes.