ACA’s Maximum Out-of-Pocket Limit Is Growing Faster Than Wages

This analysis finds that the ACA’s maximum out-of-pocket limit is likely to grow faster than wages and salaries, and is also expected to grow faster than the maximum out-of-pocket limit for Health Savings Account (HSA)-qualified health plans.

This analysis of marketplace insurers’ early rate filings in 13 states and the District of Columbia finds that they are seeking higher premium increases than in recent years, largely due to rising prices paid to hospitals, doctors and drug companies and increased use of services by enrollees.

Healthcare.gov marketplace insurers denied nearly one out of every five claims (18%) submitted for in-network services in 2020, though why the denial rates are so high and the ultimate consequences for consumers are difficult to access from the publicly available data, a new KFF analysis finds. The Affordable Care Act…

This post examines what would happen to ACA marketplace premiums for enrollees with incomes more than four times the federal policy level if the enhanced American Rescue Plan Act subsidies expire, including variations by state .

This analysis of transparency data released by the Centers for Medicare and Medicaid Services (CMS) finds that 18% of in-network claims were denied by healthcare.gov marketplace insurers in 2020, with denial rates varying widely from less than 1% to more than 80%. Consumers appealed just over one-tenth of 1% of those denied claims.

Private insurance companies are expecting to pay out $1 billion in rebates to consumers this fall under an Affordable Care Act provision that requires insurers to spend the bulk of customers’ premium payments on care, a new KFF analysis finds. Rebates are based on insurers’ experiences over the previous three…

We find that insurers estimate they will issue a total of about $1 billion in Medical Loss Ratio (MLR) rebates this year across all commercial markets under a provision of the Affordable Care Act (ACA) that limits the share of premiums that insurers can keep for administration, marketing, and profits.

Most customers with coverage through Affordable Care Act’s marketplaces will face big premium increases next year if Congress doesn’t extend the temporary enhanced tax credits included in the American Rescue Plan Act (ARPA) of 2021. If the outcome isn’t clear by summer, fall open enrollment could be a mess.

Data from the KFF Employer Health Benefits Survey demonstrates that some workers face very high contribution amounts for family coverage, including 12% who would have pay at least $10,000 annually in premiums for a family of four. These are the workers most likely to benefit from a fix to the ‘family glitch’.

Against the backdrop of public concern about inflation and rising gas prices, proposals to lower what people pay out-of-pocket for drugs tops the public’s list of health care priorities for Congress, a new KFF Health Tracking Poll finds. Most (55%) of the public say inflation is the biggest problem facing…