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Beneficiaries pay 25 percent of the price of their brand-name drugs until they reach $5,100 in out-of-pocket costs. After that, their obligation drops to 5 percent. But it never disappears.
It’s been a wild week for health policy, mostly because of developments surrounding two different legal cases. Margot Sanger-Katz of The New York Times, Joanne Kenen of Politico and Kimberly Leonard of the Washington Examiner join KHN’s Julie Rovner to sort it out with a discussion of a setback for Medicaid work requirements and the Trump administration’s decision to back a lawsuit claiming the entire Affordable Care Act is unconstitutional. Also, Rovner interviews filmmaker Mike Eisenberg about his movie “To Err Is Human: A Patient Safety Documentary.”
The decision applies only to Kentucky and Arkansas, and many experts expect the administration and other conservative states to continue to move forward on rules that would limit coverage for people who don’t work.
Colorado officials say hospitals are better off financially after the state expanded coverage to more low-income residents, but that hasn’t stopped them from shifting more costs to other insured patients.
The Justice Department asks a federal appeals court to strike down the Affordable Care Act, then, hours later, House Democrats unveil proposals to bolster the law.
After a sports injury, Esteban Serrano owed $829.41 for a knee brace purchased with insurance through his doctor’s office. The same kind of braces sell for less than $250 online.
Some plans are experimenting with the idea of closely tying hospital reimbursement rates to what Medicare pays. The approach could be a game changer in their effort to control health costs.
No one told a Washington state woman she was racking up massive out-of-pocket charges during a month-long emergency stay in an Oregon hospital. For six months, she and her husband were haunted by looming debt — and bill collectors.
Joanne Kenen of Politico, Anna Edney of Bloomberg News and Alice Miranda Ollstein of Politico join KHN’s Julie Rovner to discuss the efforts to curb “surprise” medical bills to patients who inadvertently get out-of-network care; a look at where the 2020 presidential candidates stand on health; and the Trump administration’s efforts to end HIV in the U.S. Also, Rovner interviews Food and Drug Administration Commissioner Scott Gottlieb, who is leaving his job in early April.
Medicare doesn’t pay for an annual physical, but it does cover an annual wellness visit focused on preventing disease and disability by coming up with a “personalized prevention plan” for future medical issues. It is important to use the correct term when scheduling a doctor’s visit.