insurance and costs 120121
‘An Arm and a Leg’: Need Surgery to Save Your Life? Tips for Getting Insurance to Pay
Dan Weissmann
Laurie Todd calls herself the “Insurance Warrior” and is sharing her strategies for getting health insurance companies to bend to her will.
Uninsured in South Would Win Big in Democrats’ Plan, but Hospitals Fear Funding Loss
Phil Galewitz and Andy Miller
The latest iteration of President Joe Biden's social-spending package would close the health insurance gap for at least 2.2 million people, making a huge difference especially in the South, where political opposition has blocked Medicaid expansion.
KHN’s ‘What the Health?’: Compromise Is Coming — Maybe
Democratic negotiators on Capitol Hill appear to be nearing a compromise on President Joe Biden’s social spending agenda, spurred partly by Democratic losses on Election Day in Virginia. Meanwhile, the Supreme Court hints it might allow abortion providers to sue Texas over its restrictive new ban. But the relief, if it comes, could be short-lived if the court uses a second case, challenging a law in Mississippi, to weaken or overturn Roe v. Wade. Alice Miranda Ollstein of Politico, Margot Sanger-Katz of The New York Times and Mary Ellen McIntire of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews KHN’s Rae Ellen Bichell, who reported and wrote the latest KHN-NPR “Bill of the Month” feature about an emergency bill for a nonemergency birth.
Demócratas proponen ampliar beneficios de Medicare para la audición. ¿Qué pueden esperar los consumidores?
Rachana Pradhan
Investigaciones han demostrado que la pérdida de la audición puede socavar la calidad de vida de las personas mayores, lo que conduce a la soledad, el aislamiento, la depresión, y trastornos de la comunicación.
Democrats Plan to Expand Medicare Hearing Benefits. What Can Consumers Expect?
Rachana Pradhan
KHN answers questions for seniors about how this new benefit might work.
How Low Can They Go? Rural Hospitals Weigh Keeping Obstetric Units When Births Decline
Charlotte Huff
Many small hospitals have shuttered their labor and delivery units as births decline. For those who resist the trend, some studies suggest that hospitals with low deliveries are more likely to see complications for patients. Doctors and public health experts say there is no magic number to determine when it is best to close an obstetrics unit.
How Rural Communities Are Losing Their Pharmacies
Markian Hawryluk
More than 1,000 independent rural pharmacies have closed since 2003, leaving 630 communities with no retail drugstore. As 41 million people stuck in pharmacy deserts make do, the remaining drugstores struggle to survive.
Cómo las comunidades rurales están perdiendo sus farmacias
Markian Hawryluk
Las farmacias de las esquinas, que alguna vez estuvieron tanto en las grandes ciudades como en los pueblos rurales, están desapareciendo de muchas áreas del país, dejando a unos 41 millones de estadounidenses en lo que se conoce como “desiertos de farmacias”, sin fácil acceso a las farmacias.
As Big Pharma and Hospitals Battle Over Drug Discounts, Patients Miss Out on Millions in Benefits
Sarah Jane Tribble and Emily Featherston, InvestigateTV
The number of pharmacies dispensing 340B discounted drugs soared to more than 31,000 this year. Drugmakers struck back by halting some discounts. Hospitals say they are losing millions of dollars — and cutting back services to patients — as a result.
Grandes farmacéuticas y hospitales pelean por los descuentos en medicamentos, y los pacientes pierden millones en beneficios
Sarah Jane Tribble and Emily Featherston, InvestigateTV
Fabricantes de medicamentos se niegan a ofrecer descuentos a miles de farmacias contratadas por los hospitales, diciendo que el programa ha crecido más allá de su uso previsto.
Congressional Doctors Lead Bipartisan Revolt Over Policy on Surprise Medical Bills
Michael McAuliff
Congress last year shielded consumers from unexpected out-of-network charges, but hospitals and doctors have decried the arbitration plan put forward by the Biden administration for negotiating these bills as favoring insurers. More than 150 members of the House agree.
Public Opinion Is Unified on Lowering Drug Prices. Why Are Leaders Settling for Less?
Elisabeth Rosenthal
Politicians and many health experts have done their best to see the glass half-full in the plan put forward by congressional Democrats and the president. But it’s “a far cry” from what other nations do to rein in drug prices, and polls show most voters demand more protection.
KHN’s ‘What the Health?’: Boosting Confusion
Federal health officials appear poised to extend a recommendation for covid boosters to all adults, following moves by some governors and mayors to broaden the eligible booster pool as caseloads rise. Meanwhile, the Food and Drug Administration finally has a nominee to head the agency: former FDA chief Robert Califf. And Medicare premiums for consumers will likely rise substantially in 2022, partly due to the approval of a controversial drug to treat Alzheimer’s disease. Tami Luhby of CNN, Sarah Karlin-Smith of the Pink Sheet and Rachel Cohrs of Stat join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Dan Weissmann, host of the “An Arm and a Leg” podcast.
The ER Charged Him $6,500 for Six Stitches. No Wonder His Critically Ill Wife Avoided the ER.
Blake Farmer, Nashville Public Radio
With few options for health care in their rural community, a Tennessee couple’s experience with one outrageous bill could have led to a deadly decision the next time they needed help.
Vaccine-or-Test Requirements Increase Work and Costs for Governments
Amanda Michelle Gomez and Phil Galewitz
But state and local officials embrace the requirement because it creates a safer workplace while allowing employees to continue working.
Why You Can’t Find Cheap At-Home Covid Tests
Rachana Pradhan and Hannah Norman
You probably won’t be testing everyone at your Thanksgiving table for covid because the tests are expensive and hard to find. Why? The federal government is partly to blame.
Becerra Says Surprise Billing Rules Force Doctors Who Overcharge to Accept Fair Prices
Michael McAuliff
The Health and Human Services secretary says the administration has heard complaints from doctors and hospitals about the rules it unveiled for implementing the law to end surprise medical bills. But he says providers who have exploited a complicated system to charge exorbitant rates will have to bear their share of the cost — or close.
If Congress Adds Dental Coverage to Medicare, Should All Seniors Get It?
Bram Sable-Smith
Health equity advocates see a once-in-a-generation opportunity to provide a dental benefit to millions of older Americans as Congress considers expanding Medicare services. But complicating that push is a debate over how many of the more than 60 million Medicare recipients should receive dental coverage.
California Law Aims to Strengthen Access to Mental Health Services
Bernard J. Wolfson
The law doesn’t take effect until July, but its passage should force insurers to expand their rosters of therapists. Here’s how you can challenge your health plan’s mental health services until then.
New Health Plans Offer Twists on Existing Options, With a Dose of ‘Buyer Beware’
Julie Appleby
Fueled by consumer frustration with high premiums and deductibles, two new offerings promise a means for consumers to take control of their health care costs. But experts say they pose risks.
Medicare Enrollment Blitz Doesn’t Include Options to Move Into Medigap
Harris Meyer
TV ads and mailings targeting seniors tout Medicare Advantage plans this time of year, but millions choosing traditional Medicare make a costly and difficult decision about Medigap coverage, which gets much less attention.
La catarata de información sobre la inscripción a Medicare no explica bien las opciones de Medigap
Harris Meyer
En parte porque las políticas sobre el acceso y los costos de Medigap cambian dependiendo del estado, o por la información confusa, muchos beneficiarios no eligen lo que más les conviene.
As Workers Struggle With Pandemic’s Impact, Employers Expand Mental Health Benefits
Michelle Andrews
Many job-based health plans broadened their mental health and substance use coverage to make sure workers had the support they needed this year as pandemic stress lingered, the annual KFF survey finds. Also, the proportion of employers offering health insurance to their workers remained steady, and increases for premiums and out-of-pocket health expenses were moderate.
Empleadores amplían beneficios de salud mental, mientras trabajadores luchan con el impacto de la pandemia
Michelle Andrews
Muchos empleadores informaron que desde que comenzó la pandemia han realizado cambios en sus beneficios de salud mental y adicciones. La principal forma fue extender el uso de la telemedicina.
Researcher: Medicare Advantage Plans Costing Billions More Than They Should
Fred Schulte
Some insurers pocketed ‘eye-popping’ overpayments, billing records show.
Medicare’s Open Enrollment Is Open Season for Scammers
Susan Jaffe
Medicare officials say complaints are rising from seniors lured into private plans with misleading information or enrolled without their consent. In response, officials have threatened to penalize the private companies selling Medicare Advantage and drug plans if they or agents working on their behalf mislead consumers.
KHN’s ‘What the Health?’: Why Health Care Is So Expensive, Chapter $22K
Congress is making slow progress toward completing its ambitious social spending bill, although its Thanksgiving deadline looks optimistic. Meanwhile, a new survey finds the average cost of an employer-provided family plan has risen to more than $22,000. That’s about the cost of a new Toyota Corolla. Alice Miranda Ollstein of Politico, Anna Edney of Bloomberg News and Rebecca Adams of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Rebecca Love, a nurse academic and entrepreneur, about the impending crisis in nursing.
La inscripción de Medicare es temporada abierta para estafadores
Susan Jaffe
Funcionarios federales dicen que están aumentando las quejas de personas mayores engañadas para que compren pólizas sin su consentimiento, o atraídas por información cuestionable, que pueden no cubrir sus medicamentos ni incluir a sus médicos.
Your Out-of-Pocket Health Care Costs Need Not Be a Mystery
Bernard J. Wolfson
A new California law requires health insurance companies to notify consumers how much remains on their deductibles and how close they are to their annual out-of-pocket spending limits.
Tu gasto de bolsillo en atención médica no debe ser un misterio
Bernard J. Wolfson
Una ley de California firmada por el gobernador Gavin Newsom en octubre puede ayudar a clasificar una maraña de facturas médicas para entender qué cubre el plan de salud y cuándo comenzará la cobertura.
Missouri’s Thin Dental Safety Net Stretched Amid Medicaid Expansion
Bram Sable-Smith
An estimated 275,000 Missouri adults can get dental insurance now as the state has expanded who is eligible for Medicaid. But with so few dentists participating in the program, the state’s already-backlogged dental clinics are facing a glut of new clients.
Patients Get Stranded Out of Network as Insurer-Hospital Contract Talks Fall Apart
Andy Miller
As hospital systems and insurers adjust to the pandemic, their contract negotiations grow increasingly fraught. Contracts for in-network care are ending without a new deal, leaving patients suddenly with out-of-network bills or scrambling to find new in-network providers.
Stranded by the Pandemic, He Had Only Travel Insurance. It Left Him With a $38,000 Bill.
Arthur Allen
Although it’s possible to buy travel insurance that provides some health coverage, the devil is in the fine print. Obama-era laws that prevent refusal of payment for preexisting conditions don’t apply to travel insurance.
‘An Arm and a Leg’: The Insurance Warrior’s Battle Plan
Dan Weissmann
Health care — and how much it costs — is scary. But knowledge is power. Take a master class in winning insurance appeals. In the case of Matthew Lientz, taking on his insurance also meant going up against his employer.
‘An Arm and a Leg’: How to Avoid the Worst Health Insurance
Dan Weissmann
Listen to a journalist's first-person horror story on shopping for health insurance — and learn how to avoid the pitfalls.