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Medicare & Medicaid

Medicare & Medicaid

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ACA open enrollment: what’s new for 2025
Open enrollment for 2025 ACA (Affordable Care Act)-compliant health insurance is just around the corner. Let’s take a look at the various changes that consumers should be aware of this fall.

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Fact check: Is the $6,400 subsidy real?
Ads on social media – promising a $6,400 subsidy – have been flagged as misleading. Here's what you need to know about the $6,400 subsidy scam.

admitting privilege

What is admitting privilege?

healthinsurance.org health insurance glossary

What is admitting privilege?

Admitting privilege is the right granted to a doctor to admit patients to a particular hospital. The issue of admitting privilege can become a tricky situation if a patient is seeing an in-network doctor and plans to continue to see that doctor for an inpatient treatment, but the doctor only has admitting privileges at hospitals that aren’t in the patient’s insurance network. If you’re planning an inpatient procedure, you’ll want to ensure that the hospital, and any doctors who will treat you, are all in your insurance plan’s network.

However, as a result of the No Surprises Act, patients cannot be sent surprise balance bills from out-of-network providers who treat them at an in-network hospital, unless the patient has waived their rights under the No Surprises Act. This protects patients from, for example, selecting an in-network hospital for a scheduled surgery, receiving care from an out-of-network anesthesiologist while at the hospital (often without the patient being aware of the provider’s out-of-network status), and then getting an unexpected out-of-network bill from the anesthesiologist. Your rights under the No Surprises Act should be explained to you before the procedure, so that you know what to expect.

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