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The ACA Marketplace Open Enrollment season begins November 1, and with it comes looming changes to the enhanced premium tax credits, increases in out-of-pocket premium payments, new Marketplace eligibility rules, and more. Read our analysis of what these and other changes could mean for new and returning enrollees.
As Marketplace Open Enrollment nears, policy changes could leave millions of people facing substantially higher premiums and coverage loss, which could lead more consumers to purchase less expensive and less comprehensive coverage through short-term health plans. KFF analyzes short-term health policies sold by nine large insurers in 36 states, examining premiums, cost sharing, covered benefits, and coverage limitations and comparing them to ACA Marketplace plans.
This brief examines the supply of OB-GYNs in the U.S. and the share of OB-GYNs participating in the provider networks of Qualified Health Plans (QHPs) offered in the individual market in the federal and state Affordable Care Act (ACA) Marketplaces in 2021.
This brief evaluates what is currently known about fraud and abuse in the Affordable Care Act (ACA) Marketplace, including how the final Marketplace Integrity and Affordability Rule and the recently enacted budget reconciliation law change existing Marketplace enrollment and eligibility standards.
The House budget reconciliation bill contains various expansions to Health Savings Accounts (HSAs). This policy watch explains what HSAs are, how they have been used, what the key changes to HSAs would be, and how much they would cost the federal government.
This brief focuses on consumers’ understanding of health insurance costs and examines existing federal protections that seek to address barriers to understanding the cost of coverage and care, such as price transparency, self-service price estimator tools, and simplifying cost-sharing designs.
This brief discusses how consumers understand what their insurance covers, what to do when coverage for care is denied, and what protections exist to ensure that information is available and coverage determinations are fair, accurate, and timely.
This brief analyzes federal transparency data released by the Centers for Medicare and Medicaid Services (CMS) on claims denials and appeals for non-group qualified health plans (QHPs) offered on HealthCare.gov in 2023. It finds that HealthCare.gov insurers denied nearly one out of every five claims (19%) submitted for in-network services. Information about the reasons for denials is limited, and few consumers appeal claims denials.
This brief provides an overview of current lawsuits in health policy including preventive services, abortion care, gender affirming care, Medicare drug price negotiations, nursing home staffing rules, private coverage consumer protections, and protections and health coverage for Deferred Action for Childhood Arrivals (DACA) recipients; how they may be affected by the incoming Trump administration; and the implications of their potential outcomes.
Drug makers sometimes offer copay coupons to lower consumers’ out-of-pocket costs for their brand-name prescriptions, though how private health plans treat those coupons can substantially limit their value to consumers. This issue brief provides an overview of such copay adjustment programs, stakeholder arguments for and against their use, their prevalence, and federal and state efforts to address them.
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