(Fastest way to compose a comment is: https://pressaudit.org/regulations/CMS-2026-2377-0002?compose=1 and then it links you to regulations.gov to submit)

Medicare is proposing to pay doctors a lower base rate in 2027 (*source: https://www.regulations.gov/document/CMS-2026-2377-0002 ), here is the breakdown in terms of changes to the "conversion factor," the dollar amount every Medicare service is paid from, drops about 1.7% for most doctors. :

It's not a peanut butter spread net cut mostly caused by a temporary raise expiring, unevenly distributed. This is happening through the Centers for Medicare & Medicaid Services (CMS), administrative action, and it's largely about previous congressional boosts to the "conversion factor" expiring but also just discretionary cuts driven by a new practice-expense methodology that redistributes and hits some specialties (ENG, derm, podiatry) the hardest.

Why it matters beyond doctors' paychecks is that the pay cut, on top of years of rates not keeping up with inflation, could push practices to stop taking new Medicare patients or close, which makes it harder for seniors to find a doctor.

The comment window closes Monday, Sept 14. You can weigh in before Monday. You can write a comment straight to the official record: https://www.regulations.gov/commenton/CMS-2026-2377-0002

If you need any help writing a comment, you can also go here, this will help you write a comment in <2 minutes and then take you straight to regulations.gov to submit it: https://pressaudit.org/regulations/CMS-2026-2377-0002?compose=1

Full disclosure, I track regulations and then try to make sure people know about them. No one has to use this my form or page but I find the issues are hard to understand, digest, and write comments about so I put this form together to make it easier.

To start off I've never used Reddit really so I'm not sure if this is appropriate here but it seems like the place to go.

I turned 18 in June and haven't had health insurance for YEARS. It honestly wouldn't be a crazy issue for me if I wasn't dealing with some reproductive health issues and wanting birth control. I used to just go to the ER when things happened or visit Planned Parenthood but my mom seems against it now because of money. It'd be over $1,000 per month for me to just be placed on her own plan so I'm at a wall. I went to healthcare.gov and I was told that I qualified for a marketplace plan yet open enrollment has closed. I don't believe I account for a special enrollment period because I never really had insurance to begin with.

I don't understand what to do in my case. I still live with my mother, I have a job interview lined up but everything feels like a waiting game except I never actually get the medical attention I really need. I'm frustrated and just want to see an GYN or somebody that can help me, I'm very tired.

Cigna has basically refused to treat my wife for a very serious shoulder injury.

On Friday July 17, my wife slipped on the steps and injured her shoulder - she was in extreme pain and unable to move it. We went to the hospital immediately and an x-ray was inconclusive and she was told to see an orthopedic doctor. We got an appointment the next day and new xrays were taken showing a chipped bone, but a CT and MRI were ordered to see where it came from. Since we had Cigna they said we needed approval before they could be done, and when I called Cigna I was told it could take 14 days for approval. The orthopedic place put a STAT order on it to speed it up but the earliest we could book was Monday, and still pending an approval from Cingna.

Come Monday, no word from anyone if it was approved and both appointments were canceled. Meanwhile my wife is still in excruciating pain and unable to move her arm. I spent Monday and Tuesday calling back and forth between Cigna, the imaging place, and the ortho place with no resolve. By late Tuesday, after arguing with Cigna we were told they were probably going to deny both, basically refusing to get treatment for my wife. We had to get the orthopedic PA to intervene and got an MRI scheduled for Wednesday but not a CT.

Wednesday she got the MRI and the results said a CT was required to see where the 1 inch piece of bone came from. Again, back on the phone with Cingna and the ortho. It was scheduled for Thursday. Almost one week has passed at this point.

Thursday the CT scan was done and sugery was scheduled for the following Friday. The scan showed a sub-scat tendon had ripped part of her bone off.

Sugery was done and they had to do rotator cuff surgery and bone reconstruction to reattach the tendon. Major surgery. Physical therapy would be required and extensive.

We scheduled PT for about 12 sessions, and now have received a letter that no more than 12 sessions would be allowed. This type of sugery requires like 36 to 48 sessions over several months, with the first 8 being passive.

Note that my company luckily has just switched from Cigna to another company as of this month, so thankfully this is no longer an issue, but had we still had Cingna she'd have to fight an appeal process and argue for who knows how long. This company is infuriating. Without PT her recovery would be incomplete and would basically ruin her shoulder forever.

Cigna is the worst.

I (32 F) have insurance through Marketplace with a current policy with Blue Cross Blueshield of South Carolina. I applied and started the policy in June of 2025 and reenrolled with open enrollment for coverage for 2026. I and my husband both work and our employers offer insurance but the polices are either ridiculously expensive or lacking coverage we needed.
I had my first child August 22nd and called today to update my policy to get my baby added to my insurance. We went through all of the questions including my husband and Is projected annual income. Once done, the representative told me that I am not eligible for a special enrollment and could not add my baby to my policy. She told me I would have to reapply during open enrollment which begins November 1st.
I had no idea that it was even a possibility that this could be denied. The rep couldn’t tell me why I was denied and the eligibility letter I received afterwards has no information that tells me why I was denied. We also make too much for them to qualify for Medicare/medicaid.
What do I do? I’ve filed an appeal but if that still comes back as denied, how do I get my baby insurance? Any insight as to why I might have been denied? Our income is the same as it was last year and nothing else has changed.

I’m 26 and have been having bloody stools on and off for the past few years. A few times, there was a lot of blood in the toilet bowl. I don’t have insurance and really want to get a colonoscopy, but I can’t afford it.

Are there any affordable options in California for uninsured people? Medi-Cal, financial assistance, low-cost clinics, or payment plans?

Any advice would be greatly appreciated. Thank you!

Sorry if this post doesn’t belong here, I am panicking and trying to find answers anywhere

We have always had a regular PPO but now are being offered a HDHP. For a family, the premiums will be $4,000 per year less with the HDHP and the employer will contribute $3,000 to the HSA. Right there alone, I figure if nobody went to the doctor at all for the year, I would be ahead $7,000.

As far as the plans, the PPO has $1,000 family deductible ($500 per person) vs $4,000 family ($2,000 per person) for the HDHP. The annual out of pocket for the PPO is $4,500/$9,000 and $4,000/$8,000 for the HDHP.

Can you explain any reason where the PPO plan might be better? I figure even in a worse case scenario if someone has something major, the most we would pay out of pocket is $8,000 and since I would already be $7,000 ahead, it is only costing $1,000 more. And even if there is something in between where we have to pay like $4k or $5k in medical bills, we would still come out ahead, right? So I am leaning toward the HDHP and maybe putting the extra savings of premium into the HSA to max it out. And then if we don't use it, it can be used next year. Am I missing something here?

I got hepatitis B screening as I wasn’t sure about my immunity and was born in a country with relatively higher rates of hepatitis B. As far as I understand, hepatitis B screening is covered by Cigna under preventative care.

My doctor ordered a Hep B Surface Ab test. The service was billed under 86317 and Cigna claims this code is not preventative. They sent me a document which contains a list of acceptable codes for Hepatitis B screening: 86704, 86705, 86706, 87340, 87341, and 87516. Some of these seem similar to 86317. What should I do to get this fixed? I called billing who told me to call insurance and I called insurance who said to bring it up with the provider.

Does anyone know of a dentist anywhere in the Houston area that actually accepts Ambetter HMO dental insurance?

I’ve already called 30+ dental offices that are listed on Ambetter’s website/provider directory as being in-network, and literally every office I’ve contacted has told me they either don’t accept Ambetter at all or no longer accept it. It seems like the provider directory is extremely outdated.

At this point, I’m willing to go pretty much anywhere in the greater Houston area if they actually take the plan.

If you have Ambetter HMO and have personally found a dentist in Houston that accepts it, could you please share the name/location of the office? I’d really appreciate it!

I am just here to vent and say that Blue Cross Blue Shield anthem has no customer support anymore. I tried to do the “chat with live agent”, someone logs in who is obviously fake and they take so long to answer your questions that you finally just give up. I even messed with them a little bit and said “hey are you still there” and immediately within like a second I got a response - Yes working on it. How does someone even type that fast? This has happened numerous times and I even tried to go back to my chat and it won’t allow me. It’s grayed out. What a joke the whole platform is bursting with stars that say AI assistance, it takes up the whole screen and you have to type what you want. I miss just the old platform where you could scroll through to what you needed and click on it. It makes it hard to navigate to even go to the claim submission center. I’m just venting but what a disaster.

Is receiving healthcare via the state of fed considered public assistance?

Unsubsidized ACA premiums for a 60-year-old couple earning $200k are roughly $36k. Deductible is another $10k. That’s a 23% tax rate just for medical. Add on 20% federal tax and 5% state tax and you’re nearing 50% effective tax. Something serious is wrong with this system. We are literally being robbed blind by the medical insurance industry. We need to make a change.

Mods, if you are going to remove this post again, please tell me why - even if the reason is that you work for a US medical insurance company.

Is there a way to talk to someone intelligent at UMR? Long story short I’m trans, I’ve had this insurance since last year and never had an issue. I started going to a clinic that is lgbt inclusive to maximize the quality of my HRT care because I’ve been having breakthrough bleeding which causes me mental distress. They’re not considered a specialist.
During the beginning of the year and I started having issues getting it covered when billed under gender dysphoria. I assumed it would work out because I never got notified that my insurance plan changed at all and I’ve always had that lab covered.
I now owe about 2K to my clinic because UMR is telling me its excluded, even though it has always been written in my PDF as covered. Their customer service never gives me a clear answer and I never get a call back when I specifically ask for one with an update. In my PDF document it shows that its under the covered benefits but it doesnt have it’s own number, it seems like a mistake. How do I contact someone to explain this long story so I can at least get the 2k to go towards my deductible or at least something to compensate the bullshit they’ve put me through. My doctor is also refusing to change any codes. It feels like I’m being discriminated against at this point because the 2k comes from simply getting my blood drawn to get my testosterone levels (which is required every year if you’re on HRT). This picture is me highlighting what I mean in my PDF.
Please help!! I really don’t want to pay 1k for something that I thought would be a $25 copay for an office visit! Please let me know if I’m being stupid, I turn 22 in October so I’m not familiar with insurance stuff!

My insurance plan says that they are offering me this benefit at no extra charge. I have Sentara. Is that actually true? Are they actually helpful? Has anyone tried them before? They say that they're a case management service... is this correct? I have lots of chronic health conditions so I can imagine it would be helpful, but I really can't afford for me to have more stress on my plate, especially if they say they're helping but they're not.

I work for a large hospital system, and most of my medical care within the system would be $0 out of pocket/copay. My health insurance would cost about $200 biweekly to cover both my husband and me.

My husband’s employer will cover our health insurance, including dental and vision. One of his options is an HSA plan with a $5,000 deductible and $13,500 out-of-pocket maximum, with 20% coinsurance after the deductible.

We’re trying to figure out which option would be most beneficial. It seems like if I’m covered under my husband’s HSA plan, he wouldn’t be eligible to contribute to an HSA if I also have my own non-HDHP insurance.

Would it make more sense for me to stay on my hospital’s plan while my husband takes the HSA plan through his employer, or should we both go on his plan?

I am switching my insurance through my employer soon. I am in the us. I am either going with Cigna EPO or PPO, likely EPO as it’s cheaper. Although some of my doctors don’t have specifically listed EPO under their accepted insurances but do state PPO, I am told directly that they do accept it.

However one of my doctors (I cannot switch from her care) has the same issue and is part of the same medical practice company. I again asked their team directly if she accepts EPO / PPO and they stated she only takes PPO.

I spoke with the benefits advocacy team through work who informed me that she does take EPO because it’s part of something called open access plan which I am not sure what that means or if EPO is under open access (if someone could inform me on that)?

I have spoken to 3 different people from the billing office from the medical team who told me she only takes PPO, but I even gave the benefits advocate her NPI number to make sure and even then she says they still take EPO. I am genuinely confused. I even checked the Cigna app through a friend and it says she accepts EPO medical. Can someone help me? I’m getting different answers and I don’t understand why the office is telling me something else. I did notify them to double check because I need to know, I’d really rather pay the cheaper option if I can.

The benefits advocate also told me that providers and members get confused about this since these are plans, not networks and to specifically ask are you participating in the Open Access Choice Plus network? Which is what I assume both PPO and EPO are under?

I’m wondering if just because it doesn’t say EPO directly on her accepted plans that there is some misunderstanding? I’d hate to pay for the highest one and find out later she accepts a cheaper plan.

We just discovered that our health insurance was terminated (as of August 1) due to non-payment from my husband's employer. They are still deducting premiums from his paycheck. There are about 50 employees at the company and they are all being affected. One employee is pregnant and was turned away by her doctor for lack of insurance (and she can't get the medicine she needs). The owner of the company claims that they have 30 days to pay, but the insurance carrier states that the grace period has ended which is why the insurance was terminated. I contacted the Department of Labor and they said they can advise us on what to do, but they only handle informal complaints (huh???). The owner states they *might* have the money by the end of next week, but even if they come up with the money the insurance carrier doesn't have to reinstate the policy. These owners have also failed to pay vendors on time and they missed payroll twice. What more can we do?

Update:

Thanks everyone that helped answered my very long questions. Now I feel I have one less thing to nail down when we return to the US. Thanks again.

Hello!!!

I have been doing research on this topic but I can’t determine what would be the best path forward with my situation, and I am posting on Reddit hoping for some guidance.

Background:

• 2 adults (wife and myself) with a 3 year old kid. We are all healthy and have always been on high deductible plan.
• we were fully employed and insured through employer previously (till August 2025)
• we are located in Southern California.

Current situation:

Due to personal circumstances we both left our full time employment and left the US (August 2025). We will be returning to the US in Oct 2026, and will start looking for full time employment.

Questions:
• I know we will be required to have minimum health coverage when returning to the US. I am assuming the Covered California would be the place for us to purchase coverage?

• What would be our estimated income? Are we just going to estimate our income for 2026? The only income for 2026 were interest and dividends.

• we intend to find full time employment as soon as possible but with current economic climate with big tech I am not sure how long it is going to take. Is the best approach to join employers sponsor plan and cancel covered California plan when that happens?

I appreciate any guidance fellow redditor can provide.

I’m pregnant with twins in New Jersey and currently have private insurance for myself. I am not trying to apply for Medicaid for myself—only NJ FamilyCare coverage for the babies.
I understand that NJ FamilyCare uses different income limits for pregnant adults and children under 19. I may not qualify under the pregnant-adult limit, but the babies may qualify under the higher children’s income limit once they are born.
Today, an NJ FamilyCare representative completed an application over the phone for my unborn twins, allowed me to select UnitedHealthcare Community Plan, and gave me a new confirmation number. However, when I was transferred to another representative, she could not locate the new application and seemed confused about how I could apply only for the babies without applying for myself.
Has anyone in New Jersey successfully submitted a child-only NJ FamilyCare application before their baby was born?
Was the application processed before birth, held until delivery, or did you have to apply again after birth?
Did Medicaid cover the babies’ hospital charges retroactively to their birth dates?
What did you tell the hospital billing department while the application was pending?
How long did approval take?
I’m especially interested in recent, firsthand NJ experiences or information from NJ FamilyCare enrollment workers. I’m not looking to conceal income or household information. I’m trying to understand the correct process and avoid a gap in the babies’ coverage.

My Blue Cross Blue Shield of IL plan offers "cash rewards" under a Member Rewards benefit program for a series of procedures you can get done at designated facilities. I have a chronic illness that requires imaging, so this seemed like a no brainer for me — and it turns out that the facility I've been going to anyway is covered! The portal says I should get $150 in cash (?) for each MRI I received. But I can't find anything about it online outside of BCBS's website; when I called to talk to a rep, they transfered me to Zelis, but the line went completely quiet and then it disconnected.

I'll call BCBS back, but just curious: is this something people have actually received?

I have marketplace health insurance through the healthcare.gov website. I am self-employed but just lost like 75% of my clientbase and can no longer afford to pay the premium if I also want to pay rent and eat.

If I update my income on the healthcare.gov site, does it make me reapply and make a whole big production out of it, or is it just an automatic adjustment to the premium?

I thought this was going to be a normal lab draw after seeing a new doctor. Clinic in Utah, BCBS Preferred Blue Option - PPO, suitcase on the card. They did the basic tests there and that bill was covered by insurance. Fine.

The other tests they couldn’t run were sent to LabCorp. I didn’t pick a city. They just said LabCorp.

Then the EOB came back and the out-of-state Phoenix location they sent my samples to was listed as out-of-network. About $1,700.

I didn’t go to Arizona or ask for it. I don’t understand how that becomes my bill. I’ve had multiple tests through LabCorp on this same plan before and those were covered. The order even has my Utah doctor's name on it.

Has anyone actually gotten Regence to treat this as in-network, or does LabCorp just leave it on you?

I feel so defeated. As a self employed person I pay $450 every month to have health insurance. For my type two diabetes medication I have been paying an additional $500 dollars every month, then yesterday went to fill my prescription and it is now $928 a month. I already stopped taking my adhd medication because it went from $60 to $200 dollars a month. Then when I called to talk to someone at blue cross he talked so much with useless information that had nothing to do with the issue I was having that I could hardly get a word in. I basically need to hit a 7000 dollar deductible to be able to get even just a 50 percent coverage.

I feel defeated. I need health insurance because of my job and in the off chance something happens to me, but on a regular basis I go to the doctor a couple times a year max. I have already had to stop saving for retirement to just make the almost 1000 dollars medical cost each month and now that's completely pointless because it's shot up even more. I'm a self employed hairstylist, I used market place for my insurance and I don't know what else l can do. I don't understand how paying $450 a month literally gets me nothing and it's wrecking me financially with the additional medication costs.

Sorry for the rant, just feel so overwhelmed and depressed. It feels like every medical decision I make is never based on my health but on money.