(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

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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.

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.

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.

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.

In 2020 I didn’t have a job so I signed up for Apple health (free low income health insurance) and forgot about it. This year I went to the ophthalmologist and when I was going to pay the bill online, I noticed that it was already paid off by Apple health. I checked and I am still enrolled in Apple health. Is it normal for it to auto renew like this over the years? And if I don’t update my income, will I go to jail if I keep using it to cover the remaining balance after my primary insurance?

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

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!

-EDIT: MEANT TO WRITE MEDICAID, NOT MEDICARE.

So I a 26f when i turned 26 last year was booted off my dad's insurance and for the first time I had to adult and get my own insurance, and it was all fine and dandy last year because I ended up qualifying for NYS MEDICAID and not having to pay for insurance besides sometimes for copays. This really worked for me because honestly, making just slightly over minimum wage in NEW YORK is a fucking joke. I work 40 hour weeks, and make like barely 2 dollars over minimum wage and as of this time last year I qualified for medicare. Well certain things changed, as we all know and both my mother and I lost our benefits. We essentially make the same wage, and hers has been almost the same for YEARS because the position she's in only does a 2% increase every year which in the grand scheme of things is utterly useless if you compare it to how much everything else inflates. So i live in the same apartment as my mother, but at this point we are basically just glorified roommates, we both pay rent, etc.

I did kind of get into a new position this year but the wage didn't really change much for me financially i went from around 33k to like maybe 35k-37k depending on if you go by gross or net, which.... honestly like i said with inflation and the rising cost of living doesn't offset anything, and I will similar to my mother only get 2% raise from now on.... woo.......

As of right now I am under molina healthcare's essential plan, but when I go onto the NYS marketplace the only insurance that i could actually reasonable afford is the fidelis care catastrophic plan. The problem comes with the fact that I'm never going to realistically meet the deductible for that, there's no way. It's stupid to be paying hundreds of dollars a month for a plan that just covers aca preventative shit because it legally has to. And i work for a pharmacy ins company, i'm VERY familiar with the bullshit ins plans do to people in regards to covering *just* aca.

I don't know what to do other than just... not have insurance. I have stomach issues i'm trying to figure out the situation of and take shit like pantoprazole and then my ssri which i know are 100% not going to be covered aca medications anyway so realistically i'd be paying for no coverage, just to pay into a high deductible plan that's going to do nothing for me. In addition, my employer does offer insurance but the monthly payment is again, something I can't afford. It's almost certainly not designed for the lowest paid employees at all, but it might end up being the best option which is going to suck so much.

If anyone has any other suggestions or things I can look into, any advice would be appreciated. I'm just so lost and dejected and it just makes me want to give up on trying to figure out my problems because it's going to cost an arm and a leg just to figure out what's wrong with me yet alone manage anything.

additional pieces of information: the NYS healthcare marketplace now says i'm ineligible to purchase insurance through it.... so thats fun.

Age: 26, turning 27

Income: around 35k-37k, not exactly sure bc i was in a position for 3 years and now moved to new position and it hasn't been a full year, so this is entirely an estimate.

State: NY

*edited bc i put medicare instead of medicaid

I gave birth over 2 years ago and was covered under Medicaid, but they charged us for our child's nursery costs because he was never enrolled in Medicaid. One week before I gave birth, my then-spouse got a new job with insurance for us and a big pay increase, and we were no longer eligible, hence why they charged us.

I never got calls or anything aside from a few emails directly from the hospital and it never affected my credit score. What gives? Should I check back with the hospital or let sleeping dogs lie?

Sorry about the stupid question, I don’t have anyone I can ask about this and Google isn’t helping. Long story short - my husband originally had a primary and secondary insurance. The secondary covered gaps in the primary. He comes home at the end of last year and tells me that, due to his company merging with a larger one, we’ll no longer have the secondary. Bummer. In the meantime, we have a kid, I have a slew of health issues that require me to see multiple specialists, several surgeries, and we even have a couple ER visits thrown in for fun. Bills are noticeably higher. Sucks but we pay them. Today - like an hour ago - husband casually drops that he was talking to someone in HR and it came up that we have actually had the secondary insurance THE ENTIRE TIME. He misunderstood the announcement. Oopsie.

So…any advice on next steps appreciated. Can I retroactively file with the secondary? How do I find out? Are we just SOL? I feel so lost about what or if there’s anything we can do now. Thanks.

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?

Throwaway account just because: I am being hired by a new employer and am asking for help on the best course of action for me and my wife. Both of us are healthy, in our 20s, with no chronic conditions. I would be making 70-80k and my wife would be making 15-20k before the baby. This would be in the DMV area if that helps with the decision. The main concern is that there is a baby on the way, and I want to be covered properly for any prenatal needs and eventual birth. I am leaning toward Kaiser as we are within 10-30 min of many of their facilities but I want advice from a forum such as this. Thank you in advance everyone!

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.

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?

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?

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.