Category: Health Insurance
Why Many Nonprofit (Wink, Wink) Hospitals Are Rolling in Money
“Hospitals are some of the biggest businesses in the U.S. — nonprofit in name only,” said Martin Gaynor, an economics and public policy professor at Carnegie Mellon University. “They realized they could own for-profit businesses and keep their not-for-profit status. So the parking lot is for-profit; the laundry service is for-profit; they open up for-profit entities in other countries that are expressly for making money. Great work if you can get it.”
States struggle to help patients navigate insurance hurdle known as ‘step therapy’
Millions of Americans have experienced similar frustrations under protocols known as step therapy, or fail-first policies. Insurance companies, and the pharmacy benefit management companies that handle prescriptions for them, often refuse to cover a specific drug until after the patient has tried cheaper alternatives. Insurers argue that step therapy — taking drug treatment one step a time — prevents wasteful spending by directing patients to less expensive, but still effective, treatments.
Older Americans Say They Feel Trapped in Medicare Advantage Plans.
Medicare pays private insurers a fixed amount per Medicare Advantage enrollee and in many cases also pays out bonuses, which the insurers can use to provide supplemental benefits. Those extra benefits work as an incentive to get people to join the plan but that the plans then restrict the access to so many services and coverage for the bigger stuff.”
Health insurance, now open to all; Enrollment starts Nov.1
Starting this year, Washington Healthplanfinder has expanded access to health coverage to include immigrants who are undocumented. More Washingtonians than ever will have the opportunity to buy an insurance plan that covers important health care services.
10 Medicaid holdout states scramble to improve health coverage
The Republican-led states that have refused to expand Medicaid are trying a variety of strategies to save struggling hospitals and cover more people without full expansion, which was one of the key provisions of the Affordable Care Act.
Insurers often shortchange mental health care coverage, despite a federal law
The Biden administration is pushing insurers and state regulators to improve mental health care coverage. The move comes as overdose deaths rise and youth mental health problems grow more rampant, disproportionately affecting communities of color. Inflation and a shortage of mental health care providers, including psychiatrists and specialists who treat adolescents, further hinder access to care.
Medicare enrollment begins October 15
Did you know you have choices in your Medicare prescription drug and health coverage? Medicare’s Open Enrollment Period (October 15 – December 7) is your chance to think about what matters most to you. Plans can change from year to year, and your health needs may change, too. So it’s important to know your options.
How Washington state is treating housing as health care
pple Health and Homes is a multi-agency state program launched last year that focuses on providing housing to people with health and behavioral health challenges. What’s unique is that the program taps Medicaid dollars to pay for housing subsidies, tenant services and more.
How to create your online Medicare account
It takes just a few minutes to create your account.
Vaccines covered by Medicare Part D
Stay up to date with vaccines. Talk with your doctor about which vaccines are right for you!
How does your hospital measure up?
Trying to find a hospital nearby with doctors that accept Medicare? Or, perhaps you’re planning to have surgery or are thinking about your future needs. Visit Medicare.gov to find a hospital in your area that best meets your needs.
Health disparities cost to U.S. economy tops $450 billion a year
Most of the economic burden for racial and ethnic disparities was borne by Black/African American population (69%) due to the level of premature mortality. Native Hawaiian/Pacific Islander ($23,225) and American Indian/Alaska Native ($12,351) populations had the highest economic burden per person.
‘Grotesque Catch-22’ – Sickest Rural Adults Are the Least Likely to Be Able to Pay for Healthcare
Research on cost barriers to health care found that rural adults were more likely than urban adults to report being unable to pay their medical bills or have problems paying their medical bills. Rural adults also were more likely to use medications in ways not prescribed (like taking pills every other day or only filling prescriptions every other month) to save money on medication.
Millions of Kids Could Lose Health Coverage as States Purge Medicaid Rolls
Now that the COVID-19 public health emergency is ending, states are once again free to verify that enrollees are still qualified and cancel their coverage if they’re not. Experts warn that states could sever as many as 15 million Americans, including 7 million children, from the health coverage they relied on through the pandemic.
How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them
A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments. Company doctors then sign off on the denials in batches, according to interviews with former employees who spoke on condition of anonymity.