In Switching to Original Medicare, Beware of Medigap Plan Refusals
Open enrollment season lasts until March 31 for people enrolled in Medicare Advantage who want to switch to original Medicare, but there’s a potential hitch.
Medicare Advantage
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‘Dark Money’ Group Angles for Higher Medicare Advantage Payments
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Medicare Advantage ‘Dark Money’ Group Attempts To Win Higher Payments for Insurance Companies
Medicare Advantage insurers say a proposal by the Trump administration to keep their payments nearly flat next year may lead to service cuts that harm seniors struggling to afford health care. A decision is due by early next month.
RFK Jr.’s Very Bad Week
Episode 437HHS Secretary Robert F. Kennedy Jr. had another tough week. In addition to Kennedy having rotator cuff surgery, the nomination of his ally to become surgeon general is teetering, the controversial head of the FDA's vaccine center is resigning next month, and a new survey shows Americans trust government health officials less than they do former Biden official Anthony Fauci. Anna Edney of Bloomberg News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Shefali Luthra of The 19th join KFF Health News’ Julie Rovner to discuss these stories and more.
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Readers Lean On Congress To Solve Crises in Research and Rehab
KFF Health News gives readers a chance to comment on a recent batch of stories.
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Blurry Line Between Medical and Vision Insurance Leaves Patient With Unexpected Bill
A Wisconsin retiree with glaucoma needed her eyes examined. Her Medicare Advantage plan from UnitedHealthcare listed her optometrist’s clinic as in-network, but she learned the hard way that a clinic can be in-network and out-of-network at the same time.
By Tony Leys The Hazards of ICE for Public Health
Episode 431The Trump administration’s immigration crackdown is not just roiling politics but also directly affecting the provision of health care, medical groups say. Meanwhile, in Washington, federal spending bills have been stalled by the fight over immigration enforcement funding after the shooting death of a second person in Minneapolis this month. Maya Goldman of Axios, Alice Miranda Ollstein of Politico, and Rachel Roubein of The Washington Post join KFF Health News’ Julie Rovner to discuss those stories and more.
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Medicare Advantage Insurers Face New Curbs on Overcharges in Trump Plan That Reins in Payments
Proposed Trump administration changes to federal Medicare Advantage payments would stop health insurers from mining patient data for extra medical diagnoses that generate more bills to taxpayers even without treatment.
By Fred Schulte -
Sick of Fighting Insurers, Hospitals Offer Their Own Medicare Advantage Plans
Breakups between insurers and health systems, on top of plan cuts, left more than 3.7 million Medicare Advantage enrollees facing a tough choice last year: find new insurance or new doctors. But hospital systems say their Advantage plans can avert such upheaval, giving patients peace of mind.
By Susan Jaffe -
Kaiser Permanente To Pay $556 Million in Record Medicare Advantage Fraud Settlement
Kaiser Permanente agrees to pay $556 million to settle allegations of billing the government for conditions patients didn’t have.
By Fred Schulte -
Complaints About Gaps in Medicare Advantage Networks Are Common. Federal Enforcement Is Rare.
Health systems drop out of Medicare Advantage plans all the time. Yet government documents obtained by KFF Health News show that federal regulators rarely warn plans that their networks of health providers are so skimpy they violate legal requirements.
By Susan Jaffe -
Private Medicare, Medicaid Plans Exaggerate In-Network Mental Health Options, Watchdogs Say
A federal probe of Medicare and Medicaid plans run by private insurance companies found that the plan operators often overstated how many mental health providers were available in their networks. In some cases, investigators found providers had never had contracts with plans they were listed on.
By Tony Leys -
AI Will Soon Have a Say in Approving or Denying Medicare Treatments
A pilot program testing the use of artificial intelligence to expand prior authorization decisions in Medicare has providers, politicians, and researchers questioning Trump administration promises to curb an unpopular practice that has frustrated patients and their doctors.
By Lauren Sausser and Darius Tahir -
Trump’s DOJ Accuses Medicare Advantage Insurers of Paying ‘Kickbacks’ to Brokers
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Trump’s DOJ Accuses Medicare Advantage Insurers of Paying ‘Kickbacks’ for Primo Customers
The Department of Justice alleges that several major health insurers paid brokerages “hundreds of millions of dollars in kickbacks” to get agents to steer consumers into their Medicare Advantage plans, allegations the insurers strongly dispute.
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When Hospitals Ditch Medicare Advantage Plans, Thousands of Members Get To Leave, Too
Breakups between health providers and Advantage plans are increasingly common. The Centers for Medicare & Medicaid Services has allowed whole groups of patients to leave their plans.
By Susan Jaffe Can Congress Reconcile Trump’s Wishes With Medicaid’s Needs?
Episode 394When Congress returns next week, it will be writing a budget reconciliation bill that’s expected to cut taxes but also make deep cuts to Medicaid. But at least some Republicans are concerned about cutting a program that aids so many of their constituents. Sarah Karlin-Smith of the Pink Sheet, Tami Luhby of CNN, and Alice Miranda Ollstein of Politico join KFF Health News’ Julie Rovner to discuss this story and more. Also, Rovner interviews KFF Health News’ Rae Ellen Bichell about her story on how care for transgender minors is changing in Colorado.
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Some Rural Hospitals Ditch Medicare Advantage
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Rural Hospitals Question Whether They Can Afford Medicare Advantage Contracts
Some rural hospitals have canceled — or are considering ending — contracts with insurance companies that offer Medicare Advantage plans, saying the private policies jeopardize their finances and impede patient care.
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UnitedHealth Wins Ruling Over $2B in Alleged Medicare Advantage Overpayments
A special master found the Justice Department failed to prove wrongdoing by the giant health insurer.
By Fred Schulte