Our undercover agents conducted 31 tests on health insurance sales representatives to gauge their use of deceptive practices, such as making false statements about coverage. Agents said they had pre-existing conditions, such as diabetes, and sought coverage. In 8 tests, sales representatives engaged in potentially deceptive practices, such as claiming the pre-existing condition was covered when pl...

We make more than 1,000 recommendations annually to help improve government. We alert department heads to the recommendations that can save the most money, address issues on our High Risk List, or significantly improve their operations. This report outlines our 55 priority open recommendations for HHS as of April 2020. For example, HHS should work with its interagency biodefense team to document...

Eligible for both Medicare and Medicaid? In certain states you can get coverage from both programs through “aligned plans,” that is, private plans provided by the same or related companies. This arrangement is intended to better coordinate benefits and care delivery. Some states support the automatic assignment of “dual-eligible” beneficiaries to aligned plans. Finding out more about thes...

People whose disabilities keep them from working can apply for Social Security Disability Insurance. People who claim these benefits may also be on prescription opioids for chronic pain. Opioids are addictive and can be misused. Social Security staff must deny claims if claimants who stopped using drugs or alcohol would be employable. Staff in 5 of 6 offices we visited were confused about when to...

Before 2008, many health insurance plans provided lower benefits for mental health care than other types of medical care. Congress set parity requirements to help address this discrepancy. This means things like copayment amounts or treatment approval requirements must be equal or comparable for mental health and other care. The Departments of Labor and Health and Human Services commonly find vio...

Over 9 million low-income children who don’t qualify for Medicaid use CHIP—the Children’s Health Insurance Program. Forty-two states with certain types of CHIP programs must take steps to minimize or prevent “crowd-out”—when families substitute CHIP for private health insurance. We found that there isn’t much information on how often substitution occurs. All 42 states have at least...

Medicare beneficiaries have many decisions to make when selecting their health and prescription drug coverage. Their choices affect their out-of-pocket costs and which providers they can see. The Medicare Plan Finder website is a primary source for comparing options. Many officials who assist beneficiaries in selecting coverage—about three-quarters of those we surveyed—told us beneficiaries s...

There may be several companies selling health insurance in a given market, but we've previously found that most people generally enroll with one of a few companies. When that happens, it can mean less competition and higher premiums for that area. We updated our work with more recent private insurance data. The overall story is similar: The 3 largest companies held 80% or more of the market in at...

Since 2014, millions of people have bought health insurance through exchanges established under the Affordable Care Act. The Act set federal standards for coverage and subsidized coverage for some people with low incomes. We looked at factors driving insurer participation in exchanges, interviewing representatives of 9 insurers and reviewing data on profits and losses. Insurers told us they gene...

As of December 2017, 31 states and the District of Columbia have expanded access to Medicaid for low-income adults under the Patient Protection and Affordable Care Act. In 2017, these adults made up 20% of all Medicaid recipients. We reviewed available survey results and found that low-income adults in states that expanded Medicaid generally reported better access to health care. For example, the...