Value-Based Health Care & Medicare – Weighing the Pros and Cons

2022-07-07T10:02:30-04:00June 14th, 2022|Categories: Costs for Treatment, eNews, Medication, Treatment|

Value-based care has become a hot topic in the health care industry. The model of paying providers bonuses for better patient health outcomes and penalizing them for poor outcomes may seem like a great idea and one that would encourage a more holistic approach to patient care. Some health care experts have concerns about what this means for people on Medicare Advantage (MA), though; specifically, there may be more focus on costs and less focus on quality. Janice Horowitz, author of Health Your Self, has three primary concerns when it comes to value-based care in MA plans: Restrictions on where you [...]

Medicare Surprise: Drug Plan Prices Touted During Open Enrollment Can Rise Within a Month

2022-06-06T12:46:41-04:00June 6th, 2022|Categories: Costs for Treatment, eNews, Medication|

By Susan Jaffe May 3, 2022 Something strange happened between the time Linda Griffith signed up for a new Medicare prescription drug plan during last fall’s enrollment period and when she tried to fill her first prescription in January. She picked a Humana drug plan for its low prices, with help from her longtime insurance agent and Medicare’s Plan Finder, an online pricing tool for comparing a dizzying array of options. But instead of the $70.09 she expected to pay for her dextroamphetamine, used to treat attention-deficit/hyperactivity disorder, her pharmacist told her she owed $275.90. “I didn’t pick it up because [...]

DPC’s State Advocacy Efforts Flourish with Elevated Voice of DPC Patient Ambassadors

2022-05-09T16:58:33-04:00April 25th, 2022|Categories: Costs for Treatment, Kidney Transplant, The Kidney Citizen, Uncategorized|

Image: Medigap champion Kentucky State Rep. Tom Burch and Elizabeth Lively, DPC Eastern Region Advocacy Director By Kelly Goss, J.D., LL.M., Western Region Advocacy Director and Elizabeth Lively, Eastern Region Advocacy Director, Dialysis Patient Citizens (DPC) It’s been a busy start in 2022 for DPC’s state advocacy efforts. Many states are holding shorter legislative sessions due to the upcoming primary elections, and several bills impacting dialysis patients have been introduced and are moving quickly through the legislative process. Legislation to expand Medigap access has been introduced in Arizona, Kentucky, Louisiana, Maryland, Nebraska, New Jersey, Rhode Island, Vermont, and Wisconsin. Improving access [...]

New “No Surprises Act” Aims to Eliminate Surprise Medical Bills

2022-01-10T10:36:20-05:00January 10th, 2022|Categories: Costs for Treatment, eNews|

On January 1st, a new act known as the No Surprises Act, went into effect to protect people with group and individual health insurance from receiving unexpected out-of-network medical bills. This means that individuals with private health insurance are protected from receiving additional bills for emergency services, services from out-of-network providers at in-network facilities, and out-of-network air ambulance providers. Uninsured or self-pay individuals have new resolution opportunities if they receive a medical bill that is significantly higher than the good faith estimate they were provided, and there is also a new dispute resolution process for payment disputes between plans and providers. [...]

Research Report Finds Minimal costs to enacting Jack Reynolds Memorial Medigap Expansion Act

2022-03-29T15:57:11-04:00December 17th, 2021|Categories: Costs for Treatment, The Kidney Citizen|

By Jackson Williams, DPC Vice President of Public Policy A research report commissioned by DPC has found that passage of the Jack Reynolds Memorial Medigap Expansion Act (H.R. 1676) would add only minimal costs to the federal treasury and to seniors’ Medigap premiums. H.R. 1676  would require insurers to make Medigap plans available to End-Stage Renal Disease (ESRD) patients under the age of 65. The report from Health Management Associates (HMA) calculated the costs associated with changing the law. Under current federal law, insurers are not required to offer Medicare Supplemental Insurance (also called Medigap) plans to patients under 65 years of age. While Medicare pays for roughly 80 [...]

DPC’s New Report Card on Medigap Coverage Helps ESRD Patients Understand their Medicare Supplemental Insurance Options

2022-03-29T15:50:55-04:00December 17th, 2021|Categories: Additional Resources, Costs for Treatment, The Kidney Citizen|

By Kelly Goss, J.D., LL.M., Western Region Advocacy Director If you’re a dialysis patient under age 65 looking to purchase a Medigap plan, DPC’s new interactive Medigap Report Card will help you understand the availability of Medigap coverage in your state. Medicare Supplemental Insurance, or Medigap, is provided by private insurance companies to help Medicare enrollees cover their out-of-pocket “gap” costs – such as copays, coinsurance, and deductibles – not covered by Original Medicare. Providing accessible and affordable Medigap coverage is critical to ensuring patients with End Stage Renal Disease (ESRD) can fully cover the cost of their care, since Medicare [...]

Why DPC Fights To Maintain Private Insurance Coverage for Dialysis

2022-03-30T13:54:10-04:00December 17th, 2021|Categories: Costs for Treatment, Quality of Life, The Kidney Citizen|

By Jackson Williams, DPC Vice President of Public Policy In recent years, private insurance coverage for dialysis patients has come under attack. In 2016, the outgoing Obama Administration issued a regulation that would have prohibited charities like the American Kidney Fund (AKF) from assisting patients with premiums. Several insurers unilaterally refused to accept checks from AKF or eliminated dialysis providers from their networks. Some employers have tried to restrict coverage for dialysis by amending their health plan language. The SEIU labor union promoted legislation and ballot initiatives, most notably in California, to restrict or eliminate insurance coverage for dialysis. DPC has [...]

H.R. 1676 – The Jack Reynolds Memorial Medigap Expansion Act

2022-03-30T13:03:25-04:00December 17th, 2021|Categories: Costs for Treatment, Quality of Life, The Kidney Citizen|

By Megan Hashbarger, Vice President of Government Relations Earlier this year, The Jack Reynolds Memorial Medigap Expansion Act (H.R. 1676) was reintroduced by Congresswoman Cynthia Axne (D-IA-03) to ensure all End Stage Renal Disease (ESRD) patients have access to Medigap. This Congress, we were very pleased she was joined by Congresswoman Jaime Herrera Beutler (R-WA-03) in leading this effort. Ensuring all ESRD patients have access to Medigap is extremely important to help patients cover the high costs of care and to improve their access to transplantation. Medigap policies are standardized, private insurance policies that cover costs not covered by Medicare, such [...]

CMS Makes it Easier for Consumers to Find Prices on Hospital Services

2021-05-13T11:26:25-04:00May 11th, 2021|Categories: Costs for Treatment, eNews|

The Centers for Medicare & Medicaid Services (CMS) issued a new rule on hospital price transparency that went into effect January 1, 2021. Under a section of the Public Health Service Act (PHSA), hospitals are required to publish a list of standard charges each year. Originally, hospitals could fill this requirement just by publishing their chargemaster list (a comprehensive list of all products, procedures, and services provided by a hospital) online; now, however, hospitals are told exactly what they are required to publish, and how to publish it, in order to comply with the PHSA. Hospitals must publish the following five [...]

Medicare Advantage Now Open for Enrollment

2020-12-11T09:22:52-05:00October 15th, 2020|Categories: Costs for Treatment, Fact Sheet, The Kidney Citizen|

Between now and December 7, dialysis patients are, for the first time, able to choose a Medicare Advantage plan for their coverage. Medicare Advantage is an alternative to traditional Medicare run by private insurance companies. To help kidney patients explore their options, Dialysis Patient Citizens has established Dialysis Plan Choice, an online tool designed in collaboration with Consumers’ Checkbook for dialysis patients to quickly and easily compare their current Medicare Fee-For-Service plan with the options available to them through Medicare Advantage. DialysisPlanChoice.org helps patients and caregivers more easily understand what plans are available to them, the costs are associated with those plans, and, most importantly, which plans [...]

Go to Top