Topics: Insuring Your Health, Insurance, Hospitals, Health Costs, Delivery of Care
Michelle Andrews answers a reader question about emergency room and out-of-network hospital cost changes under the health law.
QUESTION: I went to an out-of-network hospital but my insurance case worker told me I would be covered since I was admitted through the ER. Can my insurer now deny coverage? -- Michael
ANDREWS: It's unlikely that your insurer would deny coverage altogether if you were admitted to an out-of-network hospital. But it might refuse to cover your hospital care at in-network rates. Consumers now have better protection for emergency care they receive at out-of-network facilities. Under the health care overhaul, in most instances insurers can't charge higher copayments or coinsurance if people wind up getting emergency care at an out-of-network hospital. However, if you're admitted to the hospital following a visit to an out-of-network ER, you're no longer protected from higher cost-sharing. The insurer can charge you for your hospital care based on your plan's regular out-of-network coverage rules.
Topics: Insuring Your Health, Insurance
Michelle Andrews answers a reader question about having to repay an insurer that says it reimbursed too much after the patient received care from an out-of-network provider.
QUESTION: I recently received a bill from my insurer related to a pre-approved operation three years earlier with an out-of-network provider. The insurer says it mistakenly reimbursed me too much and I owe $9,100. Can they do this? – Lisa.
ANDREWS: They may be able to ask you to repay that money. These situations can come up for different reasons, but often you’ll see it in instances when someone receives care from an out-of-network providers, as you did. The insurer may send the check – or checks – directly to you, the health plan member, leaving it to you to pay the provider who delivered the care. According to insurance industry experts I spoke with, from the insurer’s perspective, that approach is sensible since they don’t have a contractual relationship with the out-of-network provider. Unfortunately that may mean that you – the health plan member – are responsible for repaying any amounts that the insurer sent you and later determines that it overpaid, even if you sent that money directly to the provider, perhaps without even cashing the check. If you want that money back to repay the insurer, you may have to go looking for it from the provider.
Michelle Andrews answers a reader question about keeping your children on your health plan until they turn 26, even if they were recently released from jail.
QUESTION: My son was taken off our policy at age 18 because he was in jail. Now, he is at home and our insurer says he cannot be added to our coverage because it was a "one-time deal." Under the ACA, is this true? -- Linda
MICHELLE ANDREWS: No, it's not true. Your son can be added to your policy again and remain on it until he turns 26, unless he has an offer of health insurance coverage through his own job. In that case, he might have to take that coverage instead. But in most cases, young adult children can stay on their parents' plan. Generally, health plans provide an open enrollment period every year when people can change their coverage or add dependents to their plan, and you should be able to do the same.
Michelle Andrews answers a reader question about keeping your children on your health plan until they turn 26, even if they move away.
ANDREWS: You're right. Even if an adult child no longer lives nearby, in most instances the health reform law allows him to stay on your health plan until he turns 26. As a practical matter, though, he may run into difficulties. Even though he has insurance he may have a hard time finding providers that are in your health plan's network if he lives out of state. In that case he -- or you -- could wind up paying a lot more for him to use out-of-network doctors. Some adult children sidestep the problem by waiting to go to the doctor until they come back home to visit mom and dad. Maybe that will work for your son. But children who have chronic health conditions may have a tougher time delaying medical care. In those cases, you may want to explore other options, like state-based plans that guarantee coverage for people with pre-existing conditions.
Topics: Insuring Your Health, Insurance, Marketplace
Michelle Andrews answers a reader's question about whether retiree health plans must comply with new rules under the ACA.
ANDREWS: The new company may be correct. Health insurance plans that cover only retirees generally don't have to abide by the provisions of the Affordable Care Act. I've seen this issue come up with older parents who have adult children. Under the health care overhaul, health plans have to allow adult children to remain on their parents' health insurance plans until the reach age 26 in most instances. But if the parents are retired and covered by a retiree-only plan, those health reform provisions don't apply. Experts I asked say the rationale may have been a concern by those drafting the law that if they made retiree-only plans subject to it, employers would discontinue coverage. If the plan you're in contains both active and retired workers, I'm told it would be subject to the law. It's worth double-checking with the company to make sure that's not the case.
Topics: Insuring Your Health, Insurance, Health Costs
Michelle Andrews answers a reader's question about employers who charge a different premium to cover a spouse who has coverage available through his or her own job.
Topics: Insuring Your Health, Medicare, Delivery of Care
Consumer columnist Michelle Andrews answers a reader question about what triggers Medicare's penalties for hospitals who readmit patients too frequently.
Topics: Insurance, Health Reform
Consumer columnist Michelle Andrews answers a reader question about under-26 insurance coverage for newlyweds.
Topics: Insurance, Women's Health, Health Reform
Consumer columnist Michelle Andrews answers a reader's question about the health law’s provision on no-cost birth control.
>> Watch Andrews answer more of your health insurance questions.
>> Read "Insuring Your Health" - a collection of Andrews' consumer columns
Q. Is it true that all birth control should now be provided free of cost to all women? I thought this provision of the ACA had gone into effect months ago. I know some women who are still being charged. -- Marilyn
A. Under the health care overhaul's expansion of preventive coverage, women may be eligible to receive free contraceptive services, including all FDA-approved methods of birth control. But there are some exceptions: The provisions apply to new private health plans; plans that have "grandfathered" status under the law don't have to comply with the new rules. As time passes, more plans are losing their "grandfathered" status, but a significant proportion are still exempt from the requirement. In addition, health plans sponsored by certain nonprofit religious employers like churches, synagogues and other houses of worship -- are completely exempt from the requirement. And some religiously affiliated institutions like faith-based hospitals and universities aren't subject to the new rules until August 2013. By that time, the Department of Health and Human Services will have come up with new rules to enable employees of those institutions to have access to free contraception through their insurers.
Consumer columnist Michelle Andrews answers a reader question about how expectant parents can figure out which of their health insurance plans will best cover their child.
Topics: Insurance, Mental Health
Topics: Insurance, Health Costs, Hospitals
Consumer columnist Michelle Andrews answers a reader question about handling an out-of-network bill from a provider the patient didn't choose.
Topics: Health Costs, Insurance, Health Reform
Topics: Insurance, Health Costs, Medicare
Michelle Andrews answers a question about an unexpected bill a reader received after paying out-of-pocket for medical services not covered by Medicare.
Michelle Andrews answers a reader question about the obligations of insurers -- and parents -- under the 2010 health law.
Topics: Health Costs, Insurance, Marketplace, Health Reform
Michelle Andrews answers a reader question about the requirement to carry health insurance in 2014 and the options for subsidized coverage.
Topics: Health Costs, Insurance
KHN's Insuring Your Health columnist Michelle Andrews answers a reader's question about whether insurance companies cover chemotherapy pills at a lower rate -- if at all -- compared to intravenous treatment.
Topics: Insurance, Health Reform, Marketplace
"Insuring Your Health" consumer columnist Michelle Andrews answers a reader's question about keeping an under-26-year-old on a parent's health plan. Much of the time, even if the child is financially independent and has a job with insurance, the young adult can stay on the family plan.
According to the Department of Health and Human Services, certain existing group plans that are grandfathered under the health law are not required to accept an adult child if that child has an offer of insurance through his or her own job. But any group health plan has the option to cover adult children. That grandfathered exception will expire in 2014.
>> Related Story: Forget The Company Plan—The Boss Wants You On Dad's Insurance
Topics: Delivery of Care
Michelle Andrews answers a reader question about the differences in practice and qualifications between doctors and nurse practitioners. She discusses the movement to require nurse practitioners to have a clinical doctoral degree although the 2015 timeframe she describes is a goal, rather than a requirement.
Topics: Insurance, Health Costs
Michelle Andrews answers a reader question about what you can do when insurance only covers a portion of an ambulance bill.
Michelle Andrews discusses options for protecting yourself when traveling if you have a preexisting condition.
Michelle Andrews answers a consumer question about providers requesting advance payment for medical tests and other services.
See Andrews answer your other health care questions.
Topics: Health Costs, Marketplace
Michelle Andrews answers a reader question about doctors who charge extra fees for more personalized care.
Topics: Health Reform, Insurance, Marketplace
KHN’s "Insuring Your Health" columnist Michelle Andrews answers a question from a reader about "grandfathered" health plans, which don't need to comply with new rules about benefits for preventive care -- but only in the near term.
Topics: Aging, Health Reform, Insurance
KHN’s “Insuring Your Health” columnist Michelle Andrews answers that question from a reader, noting that the Affordable Care Act does affect some retired members of the military over age 65.
Michelle Andrews answers a question from a reader about who will be affected by the health law's Cadillac tax, a 40 percent excise tax on high-cost plans set to start in 2018.
Topics: Insurance, Marketplace
The health law allows parents to enroll their adult children in their insurance plan until they are 26 years old, but, Michelle Andrews says, if you have an individual plan, and not a family individual one, the distinction might allow your insurer to deny coverage to your child.
> > See related story: Survey: Key Groups Unaware Of Health Law Benefits
There are many restrictions on purchasing long term care insurance. Michelle Andrews answers a reader question about other options.
This article was produced by Kaiser Health News with support from The SCAN Foundation.
© 2013 Henry J. Kaiser Family Foundation. All rights reserved.