By Susan Jaffe, KFF Health News

For several years, Fred Neary had been seeing five doctors at the Baylor Scott & White Health system, whose 52 hospitals serve central and northern Texas, including Neary’s home in Dallas. But in October, his Humana Medicare Advantage plan — an alternative to government-run Medicare — warned that Baylor and the insurer were fighting over a new contract. If they couldn’t reach an agreement, he’d have to find new doctors or new health insurance.

“All my medical information is with Baylor Scott & White,” said Neary, 87, who retired from a career in financial services. His doctors are a five-minute drive from his house. “After so many years, starting over with that many new doctor relationships didn’t feel like an option.”

After several anxious weeks, Neary learned Humana and Baylor were parting ways as of this year, and he was forced to choose between the two. Because the breakup happened during the annual fall enrollment period for Medicare Advantage, he was able to pick a new Advantage plan with coverage starting Jan. 1, a day after his Humana plan ended.

Other Advantage members who lose providers are not as lucky. Although disputes between health systems and insurers happen all the time, members are usually locked into their plans for the year and restricted to a network of providers, even if that network shrinks. Unless members qualify for what’s called a special enrollment period, switching plans or returning to traditional Medicare is allowed only at year’s end, with new coverage starting in January.

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But in the past 15 months, the Centers for Medicare & Medicaid Services, which oversees the Medicare Advantage program, has quietly offered roughly three-month special enrollment periods allowing thousands of Advantage members in at least 13 states to change plans. They were also allowed to leave Advantage plans entirely and choose traditional Medicare coverage without penalty, regardless of when they lost their providers. But even when CMS lets Advantage members leave a plan that lost a key provider, insurers can still enroll new members without telling them the network has shrunk.

At least 41 hospital systems have dropped out of 62 Advantage plans serving all or parts of 25 states since July, according to Becker’s Hospital Review. Over the past two years, separations between Advantage plans and health systems have tripled, said FTI Consulting, which tracks reports of the disputes.

CMS spokesperson Catherine Howden said it is “a routine occurrence” for the agency to determine that provider network changes trigger a special enrollment period for their members. “It has happened many times in the past, though we have seen an uptick in recent years.”

Still, CMS would not identify plans whose members were allowed to disenroll after losing health providers. The agency also would not say whether the plans violated federal provider network rules intended to ensure that Medicare Advantage members have sufficient providers within certain distances and travel times.

The secrecy around when and how Advantage members can escape plans after their doctors and hospitals drop out worries Sen. Ron Wyden of Oregon, the senior Democrat on the Senate Finance Committee, which oversees CMS.

“Seniors enrolled in Medicare Advantage plans deserve to know they can change their plan when their local doctor or hospital exits the plan due to profit-driven business practices,” Wyden said.

The increase in insurer-provider breakups isn’t surprising, given the growing popularity of Medicare Advantage. The plans attracted about 54% of the 61.2 million people who had both Medicare Parts A and B and were eligible to sign up for Medicare Advantage in 2024, according to KFF, a health information nonprofit that includes KFF Health News.

The plans can offer supplemental benefits unavailable from traditional Medicare because the federal government pays insurers about 20% more per member than traditional Medicare per-member costs, according to the Medicare Payment Advisory Commission, which advises Congress. The extra spending, which some lawmakers call wasteful, will total about $84 billion in 2025, MedPAC estimates. While traditional Medicare does not offer the additional benefits Advantage plans advertise, it does not limit beneficiaries’ choice of providers. They can go to any doctor or hospital that accepts Medicare, as nearly all do.

Sanford Health, the largest rural health system in the U.S., serving parts of seven states from South Dakota to Michigan, decided to leave a Humana Medicare Advantage plan last year that covered 15,000 of its patients. “It’s not so much about the finances or administrative burden, although those are real concerns,” said Nick Olson, Sanford Health’s chief financial officer. “The most important thing for us is the fact that coverage denials and prior authorization delays impact the care a patient receives, and that’s unacceptable.”

The National Association of Insurance Commissioners, representing insurance regulators from every state, Puerto Rico, and the District of Columbia, has appealed to CMS to help Advantage members.

“State regulators in several states are seeing hospitals and crucial provider groups making decisions to no longer contract with any MA plans, which can leave enrollees without ready access to care,” the group wrote in September. “Lack of CMS guidance could result in unnecessary financial or medical injury to America’s seniors.”

The commissioners appealed again in March to Health and Human Services Secretary Robert F. Kennedy Jr. “Significant network changes trigger important rights for beneficiaries, and they should receive clear notice of their rights and have access to counseling to help them make appropriate choices,” they wrote.

The insurance commissioners asked CMS to consider offering a special enrollment period for all Advantage members who lose the same major provider, instead of placing the burden on individuals to find help on their own. No matter what time of year, members would be able to change plans or enroll in government-run Medicare.

Advantage members granted this special enrollment period who choose traditional Medicare get a bonus: If they want to purchase a Medigap policy — supplemental insurance that helps cover Medicare’s considerable out-of-pocket costs — insurers can’t turn them away or charge them more because of preexisting health conditions.

Those potential extra costs have long been a deterrent for people who want to leave Medicare Advantage for traditional Medicare.

“People are being trapped in Medicare Advantage because they can’t get a Medigap plan,” said Bonnie Burns, a training and policy specialist at California Health Advocates, a nonprofit watchdog that helps seniors navigate Medicare.

Guaranteed access to Medigap coverage is especially important when providers drop out of all Advantage plans. Only four states— Connecticut, Massachusetts, Maine, and New York — offer that guarantee to anyone who wants to reenroll in Medicare.

But some hospital systems, including Great Plains Health in North Platte, Nebraska, are so frustrated by Advantage plans that they won’t participate in any of them.

It had the same problems with delays and denials of coverage as other providers, but one incident stands out for CEO Ivan Mitchell: A patient too sick to go home had to stay in the hospital an extra six weeks because her plan wouldn’t cover care in a rehabilitation facility.

With traditional Medicare the only option this year for Great Plains Health patients, Nebraska insurance commissioner Eric Dunning asked for a special enrollment period with guaranteed Medigap access for some 1,200 beneficiaries. After six months, CMS agreed.

Once Delaware’s insurance commissioner contacted CMS about the Bayhealth medical system dropping out of a Cigna Advantage plan, members received a special enrollment period starting in January.

Maine’s congressional delegation pushed for an enrollment period for nearly 4,000 patients of Northern Light Health after the 10-hospital system dropped out of a Humana Advantage plan last year.

“Our constituents have told us that they are anticipating serious challenges, ranging from worries about substantial changes to cost-sharing rates to concerns about maintaining care with current providers,” the delegation told CMS.

CMS granted the request to ensure “that MA enrollees have access to medically necessary care,” then-CMS Administrator Chiquita Brooks-LaSure wrote to Sen. Angus King, I-Maine.

Minnesota insurance officials appealed to CMS on behalf of some 75,000 members of Aetna, Humana, and UnitedHealthcare Advantage plans after six health systems announced last year they would leave the plans in 2025. So many provider changes caused “tremendous problems,” said Kelli Jo Greiner, director of the Minnesota State Health Insurance Assistance Program, known as a SHIP, at the Minnesota Board on Aging. SHIP counselors across the country provide Medicare beneficiaries free help choosing and using Medicare drug and Advantage plans.

Providers serving about 15,000 of Minnesota’s Advantage members ultimately agreed to stay in the insurers’ networks. CMS decided 14,000 Humana members qualified for a network-change special enrollment period.

The remaining 46,000 people — Aetna and UnitedHealthcare Advantage members — who lost access to four health systems were not eligible for the special enrollment period. CMS decided their plans still had enough other providers to care for them.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By Paula Span, KFF Health News

The assisted living facility in Edina, Minnesota, where Jean Peters and her siblings moved their mother in 2011, looked lovely. “But then you start uncovering things,” Peters said.

Her mother, Jackie Hourigan, widowed and developing memory problems at 82, too often was still in bed when her children came to see her midmorning.

“She wasn’t being toileted, so her pants would be soaked,” said Peters, 69, a retired nurse-practitioner in Bloomington, Minnesota. “They didn’t give her water. They didn’t get her up for meals.” Her mother dwindled to 94 pounds.

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Most ominously, Peters said, “we noticed bruises on her arm that we couldn’t account for.” Complaints to administrators — in person, by phone, and by email — brought “tons of excuses.”

So Peters bought an inexpensive camera at Best Buy. She and her sisters installed it atop the refrigerator in her mother’s apartment, worrying that the facility might evict her if the staff noticed it.

Monitoring from an app on their phones, the family saw Hourigan going hours without being changed. They saw and heard an aide loudly berating her and handling her roughly as she helped her dress.

They watched as another aide awakened her for breakfast and left the room even though Hourigan was unable to open the heavy apartment door and go to the dining room. “It was traumatic to learn that we were right,” Peters said.

After filing a police report and a lawsuit, and after her mother’s 2014 death, Peters in 2016 helped found Elder Voice Advocates, which lobbied for a state law permitting cameras in residents’ rooms in nursing homes and assisted living facilities. Minnesota passed it in 2019.

Though they remain a contentious subject, cameras in care facilities are gaining ground. By 2020, eight states had joined Minnesota in enacting laws allowing them, according to the National Consumer Voice for Quality Long-Term Care: Illinois, Kansas, Louisiana, Missouri, New Mexico, Oklahoma, Texas, and Washington.

The legislative pace has picked up since, with nine more states enacting laws: Connecticut, North Dakota, South Dakota, Nevada, Ohio, Rhode Island, Utah, Virginia, and Wyoming. Legislation is pending in several others.

California and Maryland have adopted guidelines, not laws. The state governments in New Jersey and Wisconsin will lend cameras to families concerned about loved ones’ safety.

But bills have also gone down to defeat, most recently in Arizona. For the second year, a camera bill passed the House of Representatives overwhelmingly but, in March, failed to get a floor vote in the state Senate.

“My temperature is a little high right now,” said state Rep. Quang Nguyen, a Republican who is the bill’s primary sponsor and plans to reintroduce it. He blamed opposition from industry groups, which in Arizona included LeadingAge, which represents nonprofit aging services providers, for the bill’s failure to pass.

The American Health Care Association, whose members are mostly for-profit long-term care providers, doesn’t take a national position on cameras. But its local affiliate also opposed the bill.

“These people voting no should be called out in public and told, ‘You don’t care about the elderly population,’” Nguyen said.

A few camera laws cover only nursing homes, but the majority include assisted living facilities. Most mandate that the resident (and roommates, if any) provide written consent. Some call for signs alerting staffers and visitors that their interactions may be recorded.

The laws often prohibit tampering with cameras or retaliating against residents who use them, and include “some talk about who has access to the footage and whether it can be used in litigation,” added Lori Smetanka, executive director of the National Consumer Voice.

It’s unclear how seriously facilities take these laws. Several relatives interviewed for this article reported that administrators told them cameras weren’t permitted, then never mentioned the issue again. Cameras placed in the room remained.

Why the legislative surge? During the COVID-19 pandemic, families were locked out of facilities for months, Smetanka pointed out. “People want eyes on their loved ones.”

Changes in technology probably also contributed, as Americans became more familiar and comfortable with video chatting and virtual assistants. Cameras have become nearly ubiquitous — in public spaces, in workplaces, in police cars and on officers’ uniforms, in people’s pockets.

Initially, the push for cameras reflected fears about loved ones’ safety. Kari Shaw’s family, for instance, had already been victimized by a trusted home care nurse who stole her mother’s prescribed pain medications.

So when Shaw, who lives in San Diego, and her sisters moved their mother into assisted living in Maple Grove, Minnesota, they immediately installed a motion-activated camera in her apartment.

Their mother, 91, has severe physical disabilities and uses a wheelchair. “Why wait for something to happen?” Shaw said.

In particular, “people with dementia are at high risk,” added Eilon Caspi, a gerontologist and researcher of elder mistreatment. “And they may not be capable of reporting incidents or recalling details.”

More recently, however, families are using cameras simply to stay in touch.

Anne Swardson, who lives in Virginia and in France, uses an Echo Show, an Alexa-enabled device by Amazon, for video visits with her mother, 96, in memory care in Fort Collins, Colorado. “She’s incapable of touching any buttons, but this screen just comes on,” Swardson said.

Art Siegel and his brothers were struggling to talk to their mother, who, at 101, is in assisted living in Florida; her portable phone frequently died because she forgot to charge it. “It was worrying,” said Siegel, who lives in San Francisco and had to call the facility and ask the staff to check on her.

Now, with an old-fashioned phone installed next to her favorite chair and a camera trained on the chair, they know when she’s available to talk.

As the debate over cameras continues, a central question remains unanswered: Do they bolster the quality of care? “There’s zero research cited to back up these bills,” said Clara Berridge, a gerontologist at the University of Washington who studies technology in elder care.

“Do cameras actually deter abuse and neglect? Does it cause a facility to change its policies or improve?”

Both camera opponents and supporters cite concerns about residents’ privacy and dignity in a setting where they are being helped to wash, dress, and use the bathroom.

“Consider, too, the importance of ensuring privacy during visits related to spiritual, legal, financial, or other personal issues,” Lisa Sanders, a spokesperson for LeadingAge, said in a statement.

Though cameras can be turned off, it’s probably impractical to expect residents or a stretched-thin staff to do so.

Moreover, surveillance can treat those staff members as “suspects who have to be deterred from bad behavior,” Berridge said. She has seen facilities installing cameras in all residents’ rooms: “Everyone is living under surveillance. Is that what we want for our elders and our future selves?”

Ultimately, experts said, even when cameras detect problems, they can’t substitute for improved care that would prevent them — an effort that will require engagement from families, better staffing, training and monitoring by facilities, and more active federal and state oversight.

“I think of cameras as a symptom, not a solution,” Berridge said. “It’s a band-aid that can distract from the harder problem of how we provide quality long-term care.”

The New Old Age is produced through a partnership with The New York Times.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By ADRIANA MORGA, Associated Press

NEW YORK (AP) — Financial markets are volatile. Consumer confidence is at its lowest level in five years. Economists say recession risks are rising.

It all adds up to financial uncertainty for a lot of Americans. Roughly half of U.S. adults say that President Trump’s trade policies will increase prices “a lot,” according to a recent poll by The Associated Press-NORC Center of Public Affairs Research. And about half of Americans are “extremely” or “very” concerned about the possibility of the U.S. economy going into a recession in the next few months.

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Matt Watson, CEO of Origin, a financial planning app, says it’s a period of uncertainty for everyone, including experts.

“No one has a crystal ball. No one, even the people that do this professionally and have done it very successfully for many years, know what’s going to happen,” he said.

If you’re worried about how economic uncertainty might affect you, here are some expert recommendations:

Take stock of your finances

The first step to preparing for uncertain financial times is knowing your starting point, Watson said. Look at your budget or your debit card expenses so you can understand how much you spend every month.

“Take stock of where you are across a number of different categories,” Watson said.

Looking at the state of your savings and investments can also provide you with an idea of your overall financial health.

Find where you can cut back

The more nonessential expenses you can pause, the more you can save for an emergency.

“Your choice is really to cut now or cut later, so it’s easier to cut now and have a cushion,” Watson said.

If you’re having difficulty finding where to cut back, Jim Weil, managing partner at Private Vista, a financial planning firm, recommends that you divide your expenses into three buckets: needs, wants and wishes. Wishes are larger expenses that can be postponed, such as a vacation to Europe.

For the time being, cut back expenses from the wishes section until you feel like your finances are in a good place.

Take care of your mental health

Between news about tariffs and job losses, you might feel your anxiety rising. So, it’s important that you protect your mental health while also caring about your finances, said Courtney Alev, consumer advocate at Credit Karma. Sometimes, reading too much news that can affect your finances can become overbearing and create more stress than you need.

“It’s good practice to stay informed but you don’t want to let the news cycle consume you,” Alev said.

If you find yourself feeling high levels of stress or anxiety when it comes to your finances, it’s best to contact a professional who can assist you, such as a financial therapist.

If looking for regular mental health services, most health insurance covers some type of mental health assistance. If you don’t have health insurance, you can look for sliding-scale therapists around the country, including through FindTreatment.gov and the Anxiety and Depression Association of America directory.

Focus on what you can control

Rather than worrying too much on the economics of the entire country, Alev recommends that you focus on the aspects of your personal life that you can control in order to feel more confident in case there is a recession.

“Identify any changes that you might need to make to have more of a safety net in place that could give you confidence,” Alev said.

Things you can control include budgeting, creating an emergency fund and cutting unnecessary expenses.

Create an emergency fund

Whether you are worried about your job security or the high prices of goods, it’s best that you sit down and reassess your budget to create an emergency fund. An emergency fund can feel unattainable if finances are already difficult, but having even a small amount of cash saved can make the difference, Alev said.

Ideally, your emergency fund should amount to three to six months of expenses.

Weil recommends you start thinking about any special commitments that you might have in the next year or two, such as college tuition or moving. If you are planning for a large financial commitment in the near future, Weil recommends that you plan to build a larger emergency fund.

Do monthly finance check-ins

Alev recommends regularly adjusting your budget to keep your financial goals on track. Monthly budget check-ins can help identify when you are overspending or if your needs change.

“A budget is only as good as it is to help you actually make decisions, so don’t be afraid to update and adapt your budget as the months go by,” Alev said.

Choose which type of debt to tackle first

Many Americans struggle with debt, whether it’s credit card debt or student loan debt, which limits their ability to save. But, if you want to create an emergency fund while also tackling your debt, it will take some prioritization.

“I would think about different kinds of debt differently,” Weil said, adding that you can place debt in three buckets: short-, medium- and long-term debt.

Weil recommends that you prioritize paying off high-interest debt such as your credit card. By making extra payments or paying over the minimum payment, you will be able to pay it off quicker. Student loan debt and long-term debt such as a mortgage can be tackled with more modest payments while you focus on creating an emergency fund.

If you have credit card debt and you can’t make too much progress in paying it down, Alev recommends you try to eliminate or reduce the amount of credit you use.

FILE – Specialist Gregg Maloney works at his post on the floor of the New York Stock Exchange, Monday, April 28, 2025. (AP Photo/Richard Drew, File)

Don’t panic about your investments

While the stock market has had some bad days, it’s best that you are not reactive to the market. If you have investments, especially in retirement vehicles such as your 401(k), it’s best not to make rushed decisions, Alev said.

“You really want to try not to panic. It can be unnerving but most likely, you should have time to make that up,” she added. If you’re closer to retirement, Alev recommends that you look into more conservative investments.

The Associated Press receives support from Charles Schwab Foundation for educational and explanatory reporting to improve financial literacy. The independent foundation is separate from Charles Schwab and Co. Inc. The AP is solely responsible for its journalism.

Today is Saturday, May 3, the 123rd day of 2025. There are 242 days left in the year.

Today in history:

On May 3, 2003, the “Old Man of the Mountain,” a 40-foot-tall granite outcropping in Franconia, N.H. that bore the resemblance of a human face in profile, collapsed despite decades of preservation efforts.

Also on this date:

In 1802, Washington, D.C., was incorporated as a city.

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In 1937, Margaret Mitchell won the Pulitzer Prize for her novel, “Gone with the Wind.”

In 1948, the Supreme Court, in Shelley v. Kraemer, ruled that covenants prohibiting the sale of real estate to Blacks or members of other racial groups were legally unenforceable.

In 1979, the Conservative Party ousted the incumbent Labour government in British parliamentary elections; Conservative leader Margaret Thatcher would become the first female U.K. Prime Minister the following day.

In 1986, aboard the longshot horse Ferdinand, Bill Shoemaker became the oldest jockey to win the Kentucky Derby at age 54.

In 1999, the Bridge Creek–Moore tornado struck the Oklahoma City metropolitan area, causing 41 deaths and nearly 600 injuries; the tornado’s top wind speed of 321 miles per hour (517 km/hour) was the highest ever recorded on earth.

In 2015, two gunmen were killed by a SWAT team in Garland, Texas, after they opened fire outside a purposely provocative contest for cartoon depictions of the Prophet Muhammad.

In 2016, in a stunning triumph for a political outsider, Donald Trump all but clinched the Republican presidential nomination with a resounding victory in the Indiana primary election that knocked rival Ted Cruz out of the race.

In 2018, a federal grand jury in Detroit indicted former Volkswagen CEO Martin Winterkorn on charges stemming from the company’s diesel emissions cheating scandal. (Under Germany’s constitution, he could not be extradited to the U.S. to face charges.)

Today’s Birthdays:

Singer Frankie Valli is 91.
Sen. Jim Risch, R-Idaho, is 82.
Sen. Ron Wyden, D-Ore., is 76.
Singer Christopher Cross is 74.
Actor Amy Ryan is 57.
Actor Bobby Cannavale (ka-nuh-VAL’-ee) is 55.
Music executive-entrepreneur Damon Dash is 54.
Actor Christina Hendricks is 50.
Actor Dule (doo-LAY’) Hill is 50.
Country musician Eric Church is 48.
Golfer Brooks Koepka is 35.
Actor Rachel Zegler is 24.