Program on Patient and Consumer Protections

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.

About 5 million people could benefit from the fix to the Affordable Care Act’s “family glitch” that allows workers offered unaffordable family coverage to get subsidies in the marketplace – if they can show they qualify. This brief looks at some of the challenges consumers may face in deciding whether to take advantage of the fix.

This brief discusses federal mental health parity protections — what they are, who they apply to, who enforces them and key policy issues as Congress and federal agencies evaluate improvements to the law to address gaps in mental health coverage and access.

Most (53%) adults with health care debt say they have received a medical or dental bill they thought contained an error at some point in the past 5 years, and most say a state consumer assistance program would be helpful to them.

The Program on Patient and Consumer Protections provides information and policy analysis examining what consumers and patients face as they navigate the health care system, including financial barriers, administrative complexity, lack of transparency, and problems accessing providers. We focus on policies to protect consumers and patients, how effective those policies…

This post explains what’s known about how insurers use prior authorization as a tool to control costs and encourage cost-effective care, the state and federal laws that govern it, and ongoing policy debates over efforts to impose standards to limit or regulate its use.