…many state-based marketplaces are finding ways to serve the small-business community through the SHOP. In a new post for the Commonwealth Fund’s To the Point blog, CHIR experts take a look at ways that state-based marketplaces are investing in their SHOPs, and how some are seeing enrollment growth and savings for small businesses. You can find the full article here….
The past few weeks have tested the U.S. health care system, exposing major gaps in access to testing and treatment of the novel coronavirus disease (COVID-19). To combat the growing COVID-19 pandemic, which promises to create a surge of provider visits and hospitalizations, comprehensive and affordable insurance coverage is crucial to protecting the health and wellbeing of millions. In a…
By Sabrina Corlette, Kevin Lucia, and Madeline O’Brien Slowing the spread of the novel coronavirus, or COVID-19, and ensuring affected patients receive treatment requires an urgent, coordinated, and comprehensive response from the federal government and states. Efforts must include improving testing capacity, supporting providers, addressing the lack of paid sick leave, and expanding access to Medicaid for the uninsured. At…
By Sabrina Corlette, Emily Curran, and Rachel Schwab High-profile disputes between insurance companies and providers appear to be on the rise. These disputes, which can end in a provider system leaving a health plan’s network, come with high stakes for consumers, particularly as hospital systems have become more consolidated. Plan enrollees can face disruptions to their continuity of care, reduced…
…charged amount. To assess the factors leading to surprise medical bills in surgical settings, researchers at the University of Michigan analyzed claims data for seven common elective procedures representing almost 350,000 patients who underwent surgery at an in-network hospital with an in-network primary surgeon. What It Finds Twenty percent of cases across all seven elective procedures resulted in an OON…
…prohibiting private insurance companies from imposing cost-sharing on enrollees when they visit a doctor’s office, urgent care center, or emergency room to seek COVID-19 testing. The New York directive will also: Require insurers to cover telehealth services, so that patients can receive medical advice without having to leave their home. If a vaccine becomes available, require insurers to cover the…
…especially those with pre-existing conditions,” most of the $844 billion in cuts would come from the Medicaid program, which serves our nation’s most vulnerable citizens, including 45 million children and 7 million elderly with long-term care needs. Although his budget document is silent on how people with pre-existing conditions would be protected, the administration’s actions, rather than its words, speak…
…In their latest post for the Commonwealth Fund, CHIR experts Jack Hoadley and Maanasa Kona assess the implementation of an IDR process in nine states. You can read the full post here. In a separate post, available here, they, along with colleague Katie Keith, examine the experience of states that use a payment standard to govern compensation for out-of-network services….
…In their latest post for the Commonwealth Fund, CHIR faculty explore how the seven states that have adopted a payment standard for out-of-network bills have based the standard on different types of data sources: a predetermined fee schedule (like the Medicare fee schedule), which sets a reimbursement amount for each service; publicly available data from multiple insurers, like a state-run…
By: JoAnn Volk and Justin Giovannelli Health care sharing ministries (HCSMs) are arrangements in which members who follow a common set of religious or ethical beliefs agree to contribute regular payments to help pay the qualifying medical expenses of other members. HCSMs may look like insurance — and are often offered as an alternative to Affordable Care Act (ACA) plans…
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