Category Archives: Insurance

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 insurance. He welcomes questions and suggestions on insurance resources 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 insurance. He welcomes questions and suggestions on insurance resources 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

In new book, award-winning journalist offers strategies for pushing back against high health care costs

About Joseph Burns

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

Marshall Allen

Marshall Allen (Photo by James Carbone)

One of the themes in journalist Marshall Allen’s book is that few American leaders — neither politicians nor the chief executives of American companies — have been willing to fight back against high and rising health care costs. Therefore, the work of taking on the medical industry and health insurers falls to consumers, writes Allen, an award-winning investigative journalist for ProPublica.

His book, Never Pay the First Bill. And Other Ways to Fight the Health Care System and Win, came out June 22 from Penguin Publishing Group, a division of Penguin Random House. Continue reading

ACA hits new high and survives in court, but journalists still have some explaining to do

About Joseph Burns

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

With just over a week to go in June, the Affordable Care Act has already had a very successful month in two important ways.

First, the ACA hit a record for enrollment, topping 31 million Americans since the law went into effect in 2014, according to a report the federal Department of Health and Human Services (HHS) issued earlier this month. And, second, the ACA survived a challenge at the U.S. Supreme Court, as we reported last week.

To reach that figure of 31 million, the HHS report included the 20 million who have gained insurance through the marketplaces under the ACA itself and through other ACA insurance programs. Continue reading