Patient and Consumer Protections
Survey of Consumer Experiences with Health Insurance Shows Complexity, Red Tape, and Confusion Rival Affordability as a Problem
Nearly six in 10 people with health insurance experienced a problem using their insurance in the past year, with even larger shares reporting problems among people who are sick or who have mental health needs. It includes data for people with different types of coverage, including employer, Marketplace, Medicare and Medicaid, and examines affordability issues and mental health access.
News Release
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Mental Health
Proposed Mental Health Parity Rule Signals New Focus on Outcome Data as Tool to Assess Compliance
Proposed updates to federal mental health parity rules would make wide ranging changes to current standards that apply to private insurance and coverage provided by most employers. This issue brief focuses on a requirement that plans perform an “outcome analysis.”
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Health Costs
Health Care Debt In The U.S.: The Broad Consequences Of Medical And Dental Bills
The KFF Health Care Debt Survey finds that four in ten adults have some form of health care debt, with most citing one-time or short-term medical expenses as the contributor. Many of those with health care debt report making personal sacrifices and enduring financial consequences as a result of their debt, while nearly one in five think they will never be able to pay off.
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Affordable Care Act
Surprise Medical Bills: New Protections for Consumers
This summarizes key provisions of the No Surprises Act, enacted in December 2020 to address the problem of unexpected medical bills, and issues that could arise during implementation ahead of its Jan. 1, 2022 effective date.
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Affordable Care Act
Claims Denials and Appeals in ACA Marketplace Plans in 2021
This analysis of HealthCare.gov Marketplace insurers’ transparency data finds that 17% of in-network claims were denied in 2021, with denial rates varying widely across insurers. Consumers appealed less than two-tenths of 1% of denied in-network claims.
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The Health Wonk Shop: Prior Authorization in Health Insurance
Nearly 1 in 5 consumers with health insurance say their insurer delayed or denied care in the past year due to its requirements for prior authorization, a process through which insurers can require patients to obtain approval in advance before they will agree to cover specific services. Insurers point to prior authorization as…More
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Consumer Problems with Prior Authorization: Evidence from KFF Survey
This Data Note highlights findings from the KFF Consumer Survey on problems consumers have experienced with prior authorization requirements. Overall, those with Medicaid, those who are higher utilizers of care, and those who seek certain types of care such as care for a mental health condition or diabetes encountered more problems with prior authorization over the past year.
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Over 35 Million Prior Authorization Requests Were Submitted to Medicare Advantage Plans in 2021
We analyze data from CMS to examine the number and outcome of Medicare Advantage prior authorization requests in 2021, overall and by firm.
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CMS Prior Authorization Proposal Aims to Streamline the Process and Improve Transparency
This brief explains a new proposed federal regulation aimed at reducing administrative hassles involved in obtaining prior authorization for care and sets out key policy questions, including how the proposal could impact the patient experience and data privacy.
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KFF Health News: States Target Health Insurers’ ‘Prior Authorization’ Red Tape
Doctors, patients, and hospitals have railed for years about the prior authorization processes that health insurers use. The Biden administration announced a crackdown in January, but some state lawmakers are looking to go further.