Category Archives: Health Insurance

Medicare open enrollment fast approaching — What we know so far

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By Michelle Andrew
KHN / September 30th

Medicare beneficiaries who want to make changes to their prescription drug plans or Medicare Advantage coverage can do so starting Oct. 15 during the Medicare’s program’s annual open enrollment period.

There will be somewhat fewer plans to pick from this year, but in general people will have plenty of options, experts say.

And although premiums aren’t expected to rise markedly overall in 2015—and in some cases may actually decline—some individual plans have signaled significantly higher rates.

The annual open enrollment period is also a once-a-year opportunity to switch to a private Medicare Advantage plan from the traditional Medicare fee-for-service plan or vice versa.

.Rather than rely on the sticker price of a plan alone, it’s critical that beneficiaries compare the available options in their area to make sure they’re in the plan that covers the drugs and doctors they need at the best price.

The annual open enrollment period is also a once-a-year opportunity to switch to a private Medicare Advantage plan from the traditional Medicare fee-for-service plan or vice versa. Open enrollment ends Dec. 7.

Although the Centers for Medicare and Medicaid Services has released some specifics about 2015 premiums and plans, many details about provider networks, drug formularies and the like won’t be available until later this fall. Here’s what we know so far: Continue reading

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One Page Guide to the Health Insurance Marketplace | HealthCare.gov

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ACA health reform logoHere’s a quick rundown on the most important things to know about the Health Insurance Marketplace, sometimes known as the health insurance “exchange.” Follow the links for more information on each topic.

via One Page Guide to the Health Insurance Marketplace | HealthCare.gov.

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New report projects a $5.7 billion drop in hospitals’ uncompensated care costs because of the Affordable Care Act

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H for hospitalA report released today by the Department of Health and Human Services projects that hospitals will save $5.7 billion this year in uncompensated care costs because of the Affordable Care Act, with states that have expanded Medicaid seeing about 74 percent of the total savings nationally compared to states that have not expanded Medicaid.

via New report projects a $5.7 billion drop in hospitals’ uncompensated care costs because of the Affordable Care Act.

 

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Narrow networks draw few complaints from consumers – RWJF

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ACA health reform logo“The significant network changes have triggered widespread media coverage and concern among providers, policymakers and consumer advocates about policyholders’ ability to access timely, appropriate care.  However, insurers and regulators in our six study states report receiving few complaints from consumers.” — Robert Wood Johnson Foundation report.

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Barriers hinder Asian-Americans and Pacific Islanders seeking insurance, report

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By Shefali Luthra
KHN / September 24

Language and cultural issues, along with immigration concerns, could still pose major barriers to enrolling Asian-Americans, Native Hawaiians and Pacific Islanders in health insurance plans this fall, according to a report released Wednesday by Action for Health Justice, an advocacy coalition that aims to educate these populations about the health law.

The report argues that efforts to enroll people from those ethnic groups were undermined last year by ineffective translations of health law guides; limited language options on the federal online marketplace, healthcare.gov; insufficient training for enrollment assisters and complications in processing applicants’ immigration information.

If those issues are not addressed by this year’s open enrollment – which begins Nov. 15 – they will likely continue to be a roadblock to expanding coverage, according to the report. Continue reading

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Number of insurers on exchanges to rise 25 percent, HHS Says

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ACA health reform logoBy Mary Agnes Carey
KHN

The number of health insurance companies offering plans in the insurance exchange marketplaces this fall will increase by 25 percent, giving consumers more choices for coverage, Health and Human Services Secretary Sylvia Burwell announced Tuesday.

When the marketplace enrollment reopens in November, 77 new insurers will be offering coverage in the 44 states for which HHS had data, which includes the 36 states that use the federal marketplace and eight states that run their own, the department reported.

The number of competitors on the marketplaces is considered important because it signifies the vitality of the exchange and can mean increased competition and lower prices for consumers.

It also means that insurers see the health law’s online marketplaces or exchanges, as a good business opportunity, senior HHS officials said. Continue reading

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A new look at why surgical rates vary

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surgeons performing surgery in operating roomBy Michael Ollove
Stateline

Several years ago, a California study showed that a half-dozen elective surgeries were being performed far more often in Humboldt County than they were in the rest of the state.

The procedures included hip and knee replacements, hysterectomies and carotid endarterectomies, a surgery to remove plaque buildup in the carotid arteries.

Geographical variation in the delivery of health care can harm patients and increase costs. That is especially true when it comes to surgery, which is usually more expensive and riskier than less invasive treatments.

Medicaid makes up a huge portion of state budgets, so the issue of health care variation is a pressing one for states looking to hold down costs.

In Humboldt County, doctors, hospitals, and others involved in health care wondered why surgeons in their area operated so often, and if they could do anything to get closer to the state norms.

To find out, they launched the Humboldt County Surgical Rate Project, which brought together doctors, health-care advocates, community organizations, unions, colleges and small employers.

As it turned out, a large part of “what was actually happening out there” was surprisingly simple . . .

“We weren’t trying to identify anyone as a ‘bad guy,’” said Betsy Stapleton, a retired nurse practitioner who is the co-director of the Humboldt County Surgical Rate Project. “The idea was to identify what was actually happening out there and to figure out ways to address it. It led to really fascinating conversations.”

As it turned out, a large part of “what was actually happening out there” was surprisingly simple: Patients in Humboldt County weren’t playing a big enough part in their own health care decisions. Continue reading

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Insurers hesitant to cover many proton beam treatments

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Comparison_of_dose_distributions_between_IMPT_(right)_and_IMRT_(left)By Michelle Andrews
KHN

Everyone seems to agree that proton beam therapy–a type of radiation that can attack cancerous tumors while generally sparing the surrounding tissue–is an exciting technology with a lot of potential.

But some insurers and disease experts say that, until there’s better evidence that proton therapy is more effective at treating various cancers than traditional types of less expensive radiation, coverage shouldn’t be routine.

That approach doesn’t sit well with proponents, some of whom say that insurance coverage is critical for necessary research of the controversial therapy’s uses.

Critics assert that the rush to build the centers is putting a very large cart before the horse.

Meanwhile, the number of proton therapy centers — huge structures that can cost more than $200 million — continues to increase.

Fourteen are in operation in the United States and a dozen more under development, according to Leonard Arzt, executive director of the National Association for Proton Therapy.

Critics assert that the rush to build the centers is putting a very large cart before the horse. Continue reading

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How much will your x-ray cost? You can find out in New Hampshire

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This KHN story also ran in the .

When Anthem Blue Cross Blue Shield became embroiled in a contract dispute with Exeter Hospital in N.H. in 2010, its negotiators came to the table armed with a new weapon: public data showing the hospital was one of the most expensive in the state for some services.

Local media covering the dispute also spotlighted the hospital’s higher costs, using public data from a state website.

When the dust settled, the insurer had extracted $10 million in concessions from Exeter. The hospital “had to step back and change their behavior,” said health policy researcher Ha Tu, who studied the state’s efforts to make health care prices transparent.

New Hampshire is among 14 states that require insurers to report the rates they pay different health care providers —and one of just a handful that makes those prices available to consumers.

The theory is that if consumers know what different providers charge for medical services, they will become better shoppers and collectively save billions.

In most places, though, it’s difficult, if not impossible to find out how much you will be charged for medical care. And with more people enrolled in high-deductible insurance plans, there is a growing demand for accurate price information. Continue reading

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For autistic adults, coverage options are scarce

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Graphic showing an umbrella sheltering medicinesBy Michelle Andrews
KHN / September 19th

It’s getting easier for parents of young children with autism to get insurers to cover a pricey treatment called applied behavioral analysis.

Once kids turn 21, however, it’s a different ballgame entirely. Continue reading

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One-quarter of ACOs save enough to earn bonuses

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Twenty-dollar bill in a pill bottleBy Jordan Rau
KHN

About a quarter of the 243 groups of hospitals and doctors that banded together as accountable care organizations under the Affordable Care Act saved Medicare enough money to earn bonuses, the Centers for Medicare & Medicaid Services announced Tuesday.

Those 64 ACOs earned a combined $445 million in bonuses, the agency said. Medicare saved $372 million after accounting for the ACOs that did not show success, including four that overspent significantly and now owe the government money.

The bonuses, losses and Medicare savings are teensy sums in the context of a program that spends half a trillion dollars a year on care for the elderly and disabled.

But the Obama administration views the results so far as evidence that reorganizing the financial incentives for doctors and hospitals — a key element of the health law – can translate to substantial savings if the program expands nationwide. Continue reading

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Dying in America is harder than it has to be, expert panel says

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It is time for conversations about death to become a part of life.

That is one of the themes of a 500-page report, titled “Dying In America,” releasedWednesday by the Institute of Medicine.

The report suggests that the first end-of-life conversation could coincide with a cherished American milestone: getting a driver’s license at 16, the first time a person weighs what it means to be an organ donor.

Follow-up conversations with a counselor, nurse or social worker should come at other points early in life, such as turning 18 or getting married.

The idea, according to the IOM, is to “help normalize the advance care planning process by starting it early, to identify a health care agent, and to obtain guidance in the event of a rare catastrophic event.”

The IOM plans to spend the next year holding meetings around the country to spark conversations about the report’s findings and recommendations. “The time is now for our nation to develop a modernized end-of-life care system,” said Dr. Victor Dzau, president of the IOM. Continue reading

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Responding to cuts, new county committee to examine gaps in family planning health care access – Puget Sound Business Journal

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king county state mapIn response to budget cuts, the public health department for King County and Seattle is forming an oversight committee to keep tabs on, and hopefully replenish, county-run family planning health services that might slip through the cracks and leave clients with nowhere else to turn.

via Responding to cuts, new county committee to examine gaps in family planning health care access – Puget Sound Business Journal.

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Insurers limiting drug benefits shifts costs to the sick

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$100-dollar bill inside a capsuleBy Charles Ornstein
ProPublica

This story was co-published with The New York Times’ The Upshot.

Health insurance companies are no longer allowed to turn away patients because of their pre-existing conditions or charge them more because of those conditions.

But some health policy experts say insurers may be doing so in a more subtle way: by forcing people with a variety of illnesses — including Parkinson’s disease, diabetes and epilepsy — to pay more for their drugs.

By charging higher prices for generic drugs that treat certain illness, health insurers may be violating the spirit of the Affordable Care Act, which bans discrimination against those with pre-existing conditions.

Insurers have long tried to steer their members away from more expensive brand name drugs, labeling them as “non-preferred” and charging higher co-payments.

But according to an editorial to be published Thursday in the American Journal of Managed Care, several prominent health plans have taken it a step further, applying that same concept even to generic drugs. Continue reading

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States sidestep health law’s measures to curb mandates

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By Michelle Andrews
KHN / September 16, 2014

For decades, states have set rules for health coverage through mandates, laws that require insurers to cover specific types of medical care or services.

The health law contains provisions aimed at curbing this piecemeal approach to coverage. States, however, continue to pass new mandates, but with a twist: Now they’re adding language to sidestep the health law, making it tougher than ever for consumers to know whether they’re covered or not.

Confused? Policy experts fear consumers will be too.

State coverage mandates vary widely. They may require coverage of broad categories of benefits, such as emergency services or maternity care, or of very specific benefits such as autism services, infertility treatment or cleft palate care.

Some mandates require that certain types of providers’ services be covered, such as chiropractors.

They may apply to all individual and group plans regulated by the state, or they may be more limited.

Photo by Michal Zacharzewski

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