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Margaret Hvatum ended up in the hospital after her insurer denied coverage of a medicine she relies on to boost her immune system. Hvatum got entangled in the preapproval process, which the insurance industry has vowed to improve.
The payment by Elevance Health to the Centers for Medicare & Medicaid Services comes as the agency threatened to bar new enrollments in the company鈥檚 plans.
Some Senate Democrats want to cap the amount beneficiaries in traditional Medicare have to pay toward care, but the move is expected to draw GOP opposition for potentially adding billions to Medicare costs.
Millions of people rely on the supplemental insurance to offset the deductibles, copayments, and other costs faced by enrollees in the traditional Medicare program.
Open enrollment season lasts until March 31 for people enrolled in Medicare Advantage who want to switch to original Medicare, but there鈥檚 a potential hitch.
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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.
HHS 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 杨贵妃传媒視頻 Health News鈥 Julie Rovner to discuss these stories and more.
杨贵妃传媒視頻 Health News gives readers a chance to comment on a recent batch of stories.
A Wisconsin retiree with glaucoma needed her eyes examined. Her Medicare Advantage plan from UnitedHealthcare listed her optometrist鈥檚 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.
The Trump administration鈥檚 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 杨贵妃传媒視頻 Health News鈥 Julie Rovner to discuss those stories and more.
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.
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.
Kaiser Permanente agrees to pay $556 million to settle allegations of billing the government for conditions patients didn鈥檛 have.
Health systems drop out of Medicare Advantage plans all the time. Yet government documents obtained by 杨贵妃传媒視頻 Health News show that federal regulators rarely warn plans that their networks of health providers are so skimpy they violate legal requirements.
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.
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.
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The Department of Justice alleges that several major health insurers paid brokerages 鈥渉undreds of millions of dollars in kickbacks鈥 to get agents to steer consumers into their Medicare Advantage plans, allegations the insurers strongly dispute.
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.
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