Category Archives: Insurance

Costs are rising as health insurers require members to pay more for COVID-19 treatment

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at joseph@healthjournalism.org.

Research shows 72% of large health insurers are now requiring members to share in the treatment costs for COVID-19

Source: Jared Ortaliza, Matthew Rae, Krutika Amin, Matthew McGough and Cynthia Cox, “Most private insurers are no longer waiving cost-sharing for COVID-19 treatment,” (KFF, Aug. 19, 2021), accessed Aug. 20, 2021. Reprinted with permission.Research shows 72% of large health insurers are now requiring members to share in the treatment costs for COVID-19

Here’s another bit of compelling information to share with your audience: New research shows that most health insurers are requiring their members to pay their deductibles, copayments and coinsurance (if any) for COVID-19 treatment.

Until late last year, almost all health insurers did not require their members to share in the cost of COVID-19 treatment, whether they were vaccinated or not.

In recent months, however, as vaccines have become widely available, commercial health insurers have changed their cost-sharing requirements for insured members needing treatment for COVID-19, according to research that KFF and the Peterson Center on Healthcare published recently. Continue reading

How to cover research showing the U.S. health system ranks last among 11 high-income nations

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at joseph@healthjournalism.org.

Health care spending data from the OECD is shown as a percentage of GDP in 11 high-income countries versus health care system performance.

Source: Eric C. Schneider et al., Mirror, Mirror 2021 — Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries (Commonwealth Fund, Aug. 2021). Reprinted with permission.Health care spending data from the OECD is shown as a percentage of GDP in 11 high-income countries versus health care system performance.

Traveling outside the U.S. anytime soon? If so, bring your notebook and camera because going to another country may be the best way to understand why the U.S. health system ranks last —again— among 11 large, high-income nations. You could go to any one or several of the 10 nations in the Commonwealth Fund’s recent report, Mirror, Mirror 2021—Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries. Continue reading

Stories to cover before the ACA’s special enrollment period ends

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at joseph@healthjournalism.org.

Karen Politz, "How the American Rescue Plan Will Improve Affordability of Private Health Coverage"

Karen Politz, Kaiser Family FoundationThe American Rescue Plan provides better subsidies for health insurance premiums for those whose income is 100% of the federal poverty level (FPL), which is $12,880 for an individual and $26,500 for a family of four, to 400% of FPL ($51,520 for an individual and $106,000 for a family of four).

The Biden administration reported on July 14 that 2.1 million Americans had signed up for health insurance coverage on the Affordable Care Act (ACA) exchanges during a pandemic-related special enrollment period that began February 15. The next day, the administration announced a “Summer Sprint to Coverage” campaign before the special enrollment period ends on August 15.

From February 15 through June 30, 1.5 million Americans signed up on HealthCare.gov, and 600,000 enrolled in the 14 states and the District of Columbia that run their own state-based marketplaces. Since April 1, the administration noted that among those new and returning consumers, 1.2 million (34%) selected plans that require premium payments of $10 or less per month. Those lower rates are the result of increased premium subsidies under the American Rescue Plan Act (ARP) that Congress passed in March. Continue reading

Expect more pushback from insurers and hospitals over rules to limit surprise bills

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at joseph@healthjournalism.org.

Largest U.S. Health Insurers of 2021 by 2020 revenue.

ValuePenguin and LendingTree.Largest U.S. Health Insurers of 2021 by 2020 revenue. (Click to enlarge.)

On July 1, the nation’s largest health insurer, UnitedHealthcare (UHC), stopped paying out-of-network claims when its fully insured members seek non-emergency care outside of their local coverage areas, according to Nona Tepper’s reporting in Modern Healthcare.

UHC’s decision to end some out-of-network coverage caught hospitals, physicians and other providers by surprise, she wrote, adding that the move could be aimed at controlling costs and reducing payment to providers.

If providers are surprised, so too could be many of UHC’s 49 million members, particularly those who need to get care outside of their coverage areas, such as those who live in rural counties and those who need treatment for substance abuse, Tepper wrote. Continue reading

New Alzheimer’s drug draws attention from federal, independent groups

About Kerry Dooley Young and Joseph Burns

Kerry Dooley Young is an independent journalist and AHCJ's core topic leader on patient safety. Joseph Burns, a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance.

Group of Alzeimer's patients on a walk with caregivers

Photo: Global Panorama via FlickrGroup of Alzeimer’s patients on a walk with caregivers

Liz Seegert, AHCJ’s topic leader on aging, contributed to this article.

Federal policy experts and the influential Institute for Clinical Effectiveness (ICER) have announced separate discussions this month of the Biogen drug aducanumab (Aduhelm) to treat Alzheimer’s disease.

On July 15, ICER will ask one of its expert panels, the California Technology Assessment Forum, to consider the evidence available for aducanumab’s benefits and risks and vote on a series of questions about its effectiveness and value. ICER’s reports have clout because insurers use them to help determine how to cover drugs and medical treatments. The independent group earlier released a report critical of the evidence presented to date about aducanumab. Biogen, which told AHCJ it disagrees with ICER’s opinion of its drug, plans to have a representative speak at the meeting. Continue reading