This brief examines four options to promote the sale of health plan options in the individual or non-group market that are not subject to Affordable Care Act (ACA) requirements for other major medical health plans. It reviews the trade-offs involved if such loosely regulated markets take root as an alternative to the ACA-regulated market, particularly as the repeal of the individual mandate penalty takes effect next year.
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Private Contracts Between Doctors and Their Medicare Patients: Current Law, Proposed Changes and Implications for Beneficiaries
Under current law, physicians may choose to privately contract with their Medicare patients, though very few do. Under such arrangements, doctors can charge their Medicare patients any amount they determine is appropriate for their services rather than be bound to Medicare’s set fees and balance billing limits, so long as…
Private Contracts Between Doctors and Medicare Patients: Key Questions and Implications of Proposed Policy Changes
Changes in Medicare’s private contracting laws could have significant implications for beneficiaries, doctors, and the Medicare program. This brief summarizes the three options that physicians and practitioners currently have for charging Medicare patients, explains how private contracting works in Medicare under current law, and reviews current proposals on changes to private contracting in Medicare, as well as their implications for patients, physicians, and the Medicare program.
Paying a Visit to the Doctor: Current Financial Protections for Medicare Patients When Receiving Physician Services
This issue brief explains provisions in current law that shield beneficiaries from unexpected and confusing charges when they see physicians and practitioners—namely, the participating provider program, limitation on balance billing, and conditions on private contracting for doctors who opt out of Medicare or join “concierge” practices. It also analyzes the implications of modifying these provisions for beneficiaries, providers, and the Medicare program.
This issue brief summarizes what’s known about workplace wellness programs offered by employers today and the use of financial incentives to encourage workers to participate. Findings are drawn from the KFF/HRET Annual Employer Health Benefits Survey. In addition, the brief reviews proposed changes by the Equal Employment Opportunity Commission (EEOC) in federal standards governing financial incentives by workplace wellness programs and how these changes might balance the use of incentives against other discrimination and privacy protections.
This brief explores the problem of “surprise medical bills” — charges arising when an insured individual inadvertently receives care from an out-of-network provider. It reviews studies on the extent of the issue, including Kaiser Family Foundation polling data, and outlines state and federal policy responses, including rules and proposed rules for Medicare and plans in Affordable Care Act marketplaces.
Larry Levitt’s February 2016 post explains how “surprise medical bills” — unanticipated charges for out-of-network care – can happen. It describes some government approaches to the issue and outlines the challenges to protecting consumers. The post is now available at The JAMA Forum.
In his latest column for The Wall Street Journal’s Think Tank, Drew Altman discusses surprise bills for out-of-network care, and New York state’s solution to the problem. All previous columns by Drew Altman are online.
In this column for The Wall Street Journal’s Think Tank, Drew Altman discusses surprise bills for out-of-network care, and New York state’s solution to the problem.
Medicaid Premium Assistance Programs: What Information is Available About Benefit and Cost-Sharing Wrap-Around Coverage?
This issue brief examines states’ approaches to administering wrap-around benefits and cost-sharing in long-standing Medicaid premium assistance programs and the information available to beneficiaries about how to access these program features.