Proposed Rule on Medicaid Managed Care: A Summary of Major Provisions July 23, 2015 Issue Brief This issue brief summarizes major provisions of the Notice of Proposed Rulemaking (NPRM) to modernize and strengthen federal Medicaid managed care regulations, which serves as an informational guide to key proposed new federal expectations and requirements of states and managed care arrangements, and federal oversight interests moving forward.
Improving the Financial Accountability of Nursing Facilities June 28, 2013 Report This report examines nursing facility expenditures to assess relative spending increases in areas such as nursing services, administrative costs, and profits. Using California as a case study, it explores reimbursement by cost category and a standard medical loss ratio (MLR) as potential policy options to improve nursing facility financial accountability and care quality.
Awaiting New Medicaid Managed Care Rules: Key Issues to Watch March 24, 2015 Issue Brief More than half of all Medicaid beneficiaries now receive their services in risk-based managed care plans, and states’ use of managed care is expanding. States operate their own Medicaid managed care programs within federal rules and requirements. The federal regulations were last updated in 2002 and a new proposed rule is expected in Spring 2015. This brief identifies key issues in the regulation and discusses how CMS might address them.
Individual Insurance Market Performance in 2019 May 13, 2020 Issue Brief New data from 2019 suggest that insurers in the individual market remain profitable, even with average premiums falling for the first time since the ACA was implemented. These data indicate that the individual market appears to be stable in 2019, despite the repeal of the individual mandate penalty and the proliferation of loosely-regulated short-term insurance plans.
As Policymakers Debate Medicare-for-All, Analysis Finds the Medicare Advantage, Individual and Group Health Insurance Markets Appear to Be Profitable, Especially Medicare Advantage August 5, 2019 News Release Three key private health insurance markets — Medicare Advantage, the individual market and the fully-insured group market — appear to be financially healthy and attractive to insurers, according to a new KFF analysis. The private Medicare Advantage market generates significantly larger gross margins per person than the individual market or…
Financial Performance of Medicare Advantage, Individual, and Group Health Insurance Markets August 5, 2019 Issue Brief Three key private health insurance markets — Medicare Advantage, the individual market and the fully-insured group market — appear to be financially healthy and attractive to insurers. The private Medicare Advantage market generates significantly larger gross margins per person than the individual market or fully-insured market. The future of these markets has become a focus for policymakers amid the debate over Medicare for All.
Individual Insurance Market Performance in 2017 May 17, 2018 Issue Brief This brief examines recently-released annual financial data from 2017 and finds insurers selling individual market plans had their best financially since 2014, when new ACA insurance market rules took effect that guaranteed access to coverage for people with pre-existing conditions. At the same time, recent political and policy changes, including the repeal of the individual mandate penalty as part of tax reform legislation and proposed regulations to expand loosely-regulated short-term insurance plans, cloud plans’ outlook going forward.
Analysis: Individual Market Insurers Experienced Their Best Financial Year under the ACA in 2017, Though Subsequent Political and Policy Changes Complicate the Outlook for Future Years May 17, 2018 News Release Insurers in 2017 had their best financial year selling individual market health insurance since the Affordable Care Act began requiring guaranteed access to coverage for people with pre-existing conditions in 2014, though recent political and policy changes create new challenges for insurers trying to succeed in this market, new Kaiser…
Private Insurers Expect to Pay $1 Billion in Rebates to Consumers This Year for Setting Premiums Too High Relative to Medical Costs June 1, 2022 News Release Private insurance companies are expecting to pay out $1 billion in rebates to consumers this fall under an Affordable Care Act provision that requires insurers to spend the bulk of customers’ premium payments on care, a new KFF analysis finds. Rebates are based on insurers’ experiences over the previous three…
2023 Medical Loss Ratio Rebates May 17, 2023 Issue Brief This analysis finds that private insurance companies are expecting to pay out about $1.1 billion in rebates this fall under an Affordable Care Act (ACA) provision that requires insurers to spend the bulk of customers’ premium payments on care.