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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 examines the income, assets, and home equity of Medicare beneficiaries, overall and by age, race and ethnicity, and gender. Most Medicare beneficiaries live on relatively low incomes and have modest financial resources to draw upon if they need costly care or long-term services and supports.
This brief provides an overview of premiums and benefits in Medicare Advantage plans that are available for 2025 and key trends over time. Two-thirds of all Medicare Advantage plans with Part D prescription drug coverage (MA-PDs) (67%) will charge no premium (other than the Part B premium) in 2025, similar to 2024 (66%). Nearly all Medicare Advantage plans (97% or more) are offering vision, dental and hearing, as they have in previous years. However, the…
This analysis finds that CMS’s proposed cut to Medicare reimbursement for 340B drugs, and accompanying increase for other outpatient services, would reduce revenues among safety-net hospitals while increasing revenues among for-profit hospitals.
This KFF survey is a follow-up survey of adults who had ACA Marketplace insurance in 2025. The survey examines the cost concerns and coverage changes that these 2025 Marketplace enrollees are experiencing following the expiration of the enhanced premium tax credits. The survey finds that half of returning enrollees say their health care costs are “a lot higher” and most expect to cut back on basic household expenses to afford coverage.
At the start of 2025, many issues are at play that will affect Medicaid coverage, financing, and access to care. While Medicaid was not discussed much on the campaign trail, Congress may consider big changes as part of tax and spending debates and the Trump administration may make changes to Medicaid through executive actions. Amid the potential changes, this brief highlights ten key things to know about Medicaid.
The Health Spending Explorer on the Peterson-KFF Health System Tracker helps users examine five decades worth of numbers documenting expenditures by federal and local governments, private insurers, and individuals on 15 categories of health services, including hospitals, physician and clinic care, and prescription drugs.
If you qualify for the full premium subsidy for your Medicare prescription drug plan, are enrolled in traditional Medicare, and your current prescription drug plan will not be offered next year, you will be automatically reassigned by Medicare to a new prescription drug plan for coverage in the next year. But you won’t be reassigned automatically if your current plan is terminating and you chose your current plan. In that case, you will have to…
This brief describes the facts about actions taken under both the Trump and Biden Administrations related to capping insulin copayments for people with Medicare and explains the differences between their approaches.
Changes to the Medicare Part D benefit in the Inflation Reduction Act will mean lower out-of-pocket costs for Part D enrollees but higher costs for Part D plans overall, leading to concerns about possible premium increases. These FAQs provide context for understanding Part D premiums in 2025 and changes in recent years, and describe actions the Centers for Medicare & Medicaid Services (CMS) is taking to mitigate potential premium increases.
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