Julie Appleby

Unauthorized Sign-Ups Cast Shadow on Obamacare鈥檚 Record Enrollment

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The Biden administration faces what looks like a growing problem for the federal Affordable Care Act鈥檚 insurance exchange: disreputable insurance brokers enrolling people who don鈥檛 need coverage or switching them to new plans without their authorization. It happened to Michael Debriae, a restaurant server who lives in Charlotte. Unbeknownst to him, an agent in Florida […]

ACA Plans Are Being Switched Without Enrollees鈥 OK

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Insurance agents say it鈥檚 too easy to access consumer information on the Affordable Care Act federal marketplace. Policyholders can lose their doctors and access to prescriptions. Some end up owing back taxes.

A Battle Between Drugmakers and Insurers Hits Patients in the Wallet

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There鈥檚 a long-running battle between insurers and drugmakers over financial assistance programs that purport to help patients afford expensive drugs. And lately, insurers have been losing ground as lawmakers, regulators and courts weigh in. The issue is whether coupons and other copay aid many patients get from drugmakers should count toward annual insurance deductibles and […]

When Copay Assistance Backfires on Patients

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Drugmakers offer copay assistance programs to patients, but insurers are tapping into those funds, not counting the amounts toward patient deductibles. That leads to unexpected charges. But the practice is under growing scrutiny.

Biden鈥檚 Got a New Set of Orders for Obamacare. Is It His Last?

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The Biden administration has issued its latest official wish list for Obamacare insurance plans, potentially one of the last major Affordable Care Act health policy efforts in the president鈥檚 first term. Changes on tap for 2025? For one, the administration wants states that run their own ACA marketplaces to crack down on what鈥檚 called 鈥渘etwork […]

Hospitals and Doctors Are Fed up With Medicare Advantage

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Medicare Advantage plans are pretty popular with both lawmakers and ordinary Americans 鈥 they now enroll about 31 million people, representing just over half of everyone in Medicare, by KFF鈥檚 count. But among doctors and hospitals, it鈥檚 a different story. Across the country, provider grumbling about claim denials and onerous preapproval requirements by Advantage plans […]