Category: Insurance

ACA Sign-Ups for Low-Income People Roll Out Amid Brokers’ Concerns About Losing Their Cut

The Biden administration unveiled a new special enrollment option aimed at signing up low-income Americans for Affordable Care Act coverage — even if it is outside of the usual annual open enrollment period. But insurers are cutting broker commissions at the same time.

Patients’ Perilous Months-Long Waiting for Medicaid Coverage Is a Sign of What’s to Come

The pandemic crisis has overwhelmed understaffed state Medicaid agencies, already delaying access to the insurance program in Missouri. As the public health emergency ends, low-income people nationwide could find it even harder to have coverage.

KHN’s ‘What the Health?’: Funding for the Next Pandemic

In his proposed budget, President Joe Biden called for a boost in health spending that includes billions of dollars to prepare for a future pandemic. But that doesn’t include money he says is needed immediately for testing and treating covid-19. Also this week, federal regulators authorized a second booster shot for people 50 and older yet gave little guidance to consumers about who needs the shot and when. Amy Goldstein of The Washington Post, Jennifer Haberkorn of the Los Angeles Times, and Rachana Pradhan of KHN join KHN’s Mary Agnes Carey to discuss these issues and more. Plus, Julie Rovner interviews KHN’s Julie Appleby, who reported and wrote the latest KHN-NPR “Bill of the Month” episode about a very expensive air ambulance ride.

The Case of the $489,000 Air Ambulance Ride

Diagnosed with aggressive leukemia on a Western trip, a young man thought his insurance would cover an air ambulance ride home to North Carolina. Instead, questions about medical necessity left him with an astronomical bill.

How to Avoid Surprise Bills — And the Pitfalls in the New Law

The No Surprises Act offers protection from many surprise medical bills — but that protection may be only as good as a patient’s knowledge of the law and ability to make sure it’s enforced. Here’s what you need to know.

Medicare Advantage Plans Send Pals to Seniors’ Homes for Companionship — And Profits

Many Medicare Advantage plans send caregivers to the homes of seniors periodically to help with housework and provide companionship. But the workers may also prod seniors into activities that boost the plans’ Medicare ratings and federal reimbursements.

Want Vulnerable Californians to Have Healthier Pregnancies? Doulas Say the State Must Pay Up.

California was supposed to start paying doulas this year to help Medicaid enrollees have healthy pregnancies. But the benefit has been delayed because doulas feel lowballed by the state’s proposed reimbursement rate, which is below what most other states pay.

Want Vulnerable Californians to Have Healthier Pregnancies? Doulas Say the State Must Pay Up.

California was supposed to start paying doulas this year to help Medicaid enrollees have healthy pregnancies. But the benefit has been delayed because doulas feel lowballed by the state’s proposed reimbursement rate, which is below what most other states pay.

HIV Preventive Care Is Supposed to Be Free in the US. So, Why Are Some Patients Still Paying?

The Department of Labor issued rules in July clarifying that health plans need to cover the costs of prescription drugs proven to prevent HIV infection, along with related lab tests and medical appointments, at no cost to patients. More than half a year later, the erroneous billing continues.

The Demise of Single-Payer in California Trips Up Efforts in Other States

The failure of single-payer health care legislation in California casts doubt on the ability of other states to pass government-run, universal health care. But activists in New York, Washington state, and elsewhere say they are taking lessons from California and changing their tactics.