Health Costs, Health Insurance, Health Policy, Hospitals

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.”

Drugs, Health Insurance, Health Policy

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.

Health Insurance, Medicare

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, Health Policy, Mental Health

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.

Health Insurance, Medicare

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.

Farm in Maine in Autumn. Woods with fall colors.
Health Costs, Health Insurance, Medicaid, Medicare, Rural Health

‘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.