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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.
Issue Brief Read MoreWorkplace Wellness Programs Characteristics and Requirements
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.
Issue Brief Read MoreSurprise Medical Bills
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.
Issue Brief Read MoreJAMA Forum: Surprise, Surprise
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.
Perspective Read MoreIn N.Y. Policy on Out-of-Network Medical Bills, a Model for Other States?
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.
News Release Read MoreIn N.Y. Policy on Out-of-Network Medical Bills, a Model for Other States?
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.
Perspective Read MoreMedicaid 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.
Issue Brief Read MoreNew Survey Examines Assistance Provided to Consumers During Second Affordable Care Act Open Enrollment
A new Kaiser Family Foundation survey of insurance brokers and assistance programs examines the help they provided to consumers during the 2015 open enrollment period for Affordable Care Act coverage. The 2015 Survey of Health Insurance Marketplace Assister Programs and Brokers provides estimates of the number of people helped and…
News Release Read More2015 Survey of Health Insurance Marketplace Assister Programs and Brokers
This nationwide survey analysis of Marketplace consumer assistance programs and brokers examines the nature of Marketplace assistance during the second open enrollment period for 2015 coverage, and offers unique insights into how Affordable Care Act (ACA) implementation is progressing, what is changing, and what challenges remain. Building upon our Survey of Health Insurance Marketplace Assister Programs (2014), the analysis compares Assister Program capacity and experiences from the first open enrollment period to the next, and also includes the enrollment experience of brokers for the first time.
Report Read MoreComparison of Consumer Protections in Three Health Insurance Markets: Medicare Advantage, Qualified Health Plans and Medicaid Managed Care Organizations
This report examines similarities and differences in federal consumer protection standards for Medicare Advantage (MA) plans, Qualified Health Plans (QHPs), and Medicaid Managed Care Organizations (MCOs). It focuses on rules established at the federal level, though some states have chosen to go above the federal minimums and impose additional requirements for QHPs and Medicaid MCOs.
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