Premium assistance programs lead to fights between insurers, hospitals

Programs which help customers on the Affordable Care Act (ACA) marketplace buy insurance are being criticized by insurers as they pull out of the exchanges.

Kaiser Health News reports these programs have helped thousands of low-income customers purchase coverage. In one example, 21-year-old Mercedes Nimmer of Madison, Wisconsin, received assistance from UnitedWay of Dane County when federal subsidies left her with a $33 monthly premium—a considerable expense for a multiple sclerosis patient who makes $11,000 per year.

“Oh my gosh, this is a big deal for me to get this help,” Nimmer said, noting the insurance is vital to cover her medications. 

Insurers, however, argue these “steering” programs are unfair, as they drive people to marketplace plans with higher reimbursement for providers when they may qualify for Medicaid or Medicare. CMS has said it may punish dialysis centers that engage in those practices, up to and including changing their Medicaid and Medicare eligibility.

But insurers are already going to the courts to take action against groups paying for marketplace premiums. For more, click on the link below: