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  • What health benefits do Marketplace plans cover?

    FAQs

    All qualified health plans offered in the Marketplace cover the "essential health benefits" (EHB), including: Ambulatory patient services (outpatient care you get without being admitted to a hospital) Emergency services Hospitalization Maternity and newborn care (care before and after your baby is born) Mental health and substance use disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain…

  • North Carolina’s Effort to Relieve Medical Debt

    Policy Watch

    This policy watch examines the burden of medical debt in North Carolina and the state’s new plan to leverage the Medicaid program to provide debt relief and support access to care for low- and middle-income North Carolinians.

  • I notice “short-term limited-duration” insurance plans for sale outside of the Marketplace, and they are cheaper than many other health plans. What is a short-term limited-duration health plan?

    FAQs

    “Short-term limited-duration” insurance plans are intended to fill a temporary gap in health coverage, such as when someone is between jobs. The maximum duration of short-term plans varies by state. Short-term plans must disclose to consumers that these plans are “NOT comprehensive health coverage.” Short-term plans often do not have the consumer protections found in Marketplace plans. For example, short-term plans can exclude coverage of pre-existing health conditions. Also, many short-term plans do not cover essential health…

  • Recent Trends in GLP-1 Use and Spending in Medicare

    Issue Brief

    Ahead of the Trump administration’s planned expansion of Medicare coverage for GLP-1s to treat obesity through temporary models and the availability of Medicare’s negotiated price for certain GLP-1 products beginning in 2027, this analysis examines CMS’s Medicare Part D claims data from 2019 to 2024 to document the increase in the number of beneficiaries being treated with GLP-1 drugs and the growth in Medicare spending and claims for these drugs.

  • Public Trust in Vaccine Information, Misrepresented Vaccine Studies, and HIV and PrEP Stigma — The Monitor

    Feature

    This volume examines findings about trusted sources of vaccine information from the latest KFF Tracking Poll on Health Information and Trust. It also explores how the misrepresentation of studies and policy developments contribute to health narratives around vaccines, HIV and PrEP. Lastly, it summarizes new research on the use of generative AI to counteract vaccine misinformation.

  • I am covered by Medicare and my only income is $12,000 from Social Security. I have $1,000 in a savings account.  Do I qualify for any financial assistance with her Medicare coverage?

    FAQs

    Based on your current income and asset amounts, you may qualify for Medicaid. Under the current rules, Medicaid helps many low-income people on Medicare with their Medicare premiums and cost-sharing requirements and may also cover some benefits that are not covered by Medicare, such as dental services and long-term services and supports. You might also qualify for extra financial assistance to help with the cost of Medicare Part D prescription drug coverage. To find out…

  • Policy Landscape of Private Insurance Coverage of Contraception in the U.S.

    Issue Brief

    This issue brief explains the rules for private insurance coverage of contraceptives at the federal and state level, the exemptions and accommodations available for certain employers, gaps in coverage for contraceptives obtained outside of the traditional clinical setting, and how changes in the agencies responsible for making contraceptive recommendations may affect coverage for contraceptives.

  • The Affordable Care Act 101

    Feature

    This Health Policy 101 chapter provides an overview of the Affordable Care Act (ACA), a major reform of the U.S. health care system aimed at reducing high uninsured rates and alleviating issues like high out-of-pocket costs and coverage exclusions for preexisting conditions. The ACA significantly altered many aspects of the health system and the chapter explores its mechanisms, such as the Health Insurance Marketplaces, and the evolution of the law since its passage in 2010…

  • Recent Changes in Medicaid Financing in Puerto Rico and Other U.S. Territories

    Issue Brief

    The U.S territories – American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Puerto Rico, and the U.S. Virgin Islands (USVI) – have faced longstanding fiscal and health challenges exacerbated by recent emergencies. This issue brief provides background on how Medicaid financing differs between U.S. territories and states and what these differences mean for funding as well as health care coverage and access.