Higher cost sharing in private insurance has been credited with helping to slow the growth of health care costs in recent years. For families with low incomes or moderate incomes, however, high deductibles, out-of-pocket limits and other cost sharing can be a potential barrier to care and may lead these families to significant financial difficulties. This issue brief uses information from the Federal Reserve Board’s 2013 Survey of Consumer Finances to look at how household resources match up against potential cost-sharing requirements for plans offered by employers or available in the individual market, including in the Affordable Care Act marketplaces.
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In this new Policy Insight, the Kaiser Family Foundation’s Cristina Boccuti and Tricia Neuman examine how Congress’ effort to permanently stave off scheduled cuts in Medicare’s physician payments could affect what Medicare beneficiaries pay for their care — both in premiums and in other potential changes — to offset the…
New Kaiser Policy Insight and Issue Brief Examine Policy Implications and Legal Arguments in the U.S. Supreme Court’s King v. Burwell Case
With the Supreme Court set to hear oral arguments in King v. Burwell on March 4, a new Policy Insight from the Kaiser Family Foundation’s Larry Levitt and Gary Claxton explores the policy implications for consumers and insurance markets if the Court were to side with the plaintiffs in the…
Are Premium Subsidies Available in States with a Federally-run Marketplace? A Guide to the Supreme Court Argument in King v. Burwell
This issue brief examines the major questions raised by King v. Burwell, explains the parties’ legal arguments, and considers the potential effects of a Supreme Court decision about the availability of the Affordable Care Act’s premium subsidies in states with a Federally-run Marketplace.
This perspective addresses how insurance markets might respond if the US Supreme Court sides with the plaintiffs in the King v. Burwell case. The case challenges the legality of premium and cost-sharing subsidies for low- and middle-income people buying insurance in states where the federal government rather than the state is operating the marketplace under the Affordable Care Act (ACA).
Federal and State Standards for “Essential Community Providers” under the ACA and Implications for Women’s Health
Safety net providers such as community health centers and family planning clinics have served a significant role in the provision of primary care and reproductive health care services to low-income and uninsured people, particularly women. The Affordable Care Act (ACA) has a provision aimed at assuring that newly-insured individuals, as well as those without coverage, can continue seeing their trusted safety net providers, also called Essential Community Providers (ECPs). This brief reviews the definition of ECPs, examines the federal and state rules that govern the extent to which plans must include these providers in their networks, identifies the variation from state to state, and discusses the particular importance of these rules and providers for women’s access to care.
This brief analyzes state policies and insurer coverage decisions affecting the availability of abortion coverage in 2015 insurance plans offered through the Marketplaces. It finds that abortion coverage is unavailable in a total of 31 states, 24 of which have enacted laws that ban or restrict abortion coverage in plans sold through their Marketplaces and 7 of which have no abortion coverage restrictions but also have no Marketplace plans offering it.
In some states, policymakers and stakeholders are considering adoption of the Basic Health Program (BHP) option permitted under the Patient Protection and Affordable Care Act (ACA). Federal regulations allow BHP implementation beginning in 2015. Through BHP, consumers with incomes at or below 200 percent of the federal poverty level (FPL) who would otherwise qualify for subsidized qualified health plans (QHPs) offered in health insurance marketplaces instead are offered state-contracting standard health plans that provide coverage no less generous and affordable than what have been provided in the marketplace. To operate BHPs, states receive federal funding equal to 95 percent of the premium tax credits (PTCs) and cost-sharing reductions (CSRs) that BHP enrollees would have received if they had been covered through QHPs. This paper seeks to inform state-level analysts about the characteristics of BHP-eligible people in their state and how to use that information to estimate the approximate federal BHP payment amount per average BHP-eligible resident.
Medical and Prescription Drug Deductibles for Plans Offered in Federally Facilitated and Partnership Marketplaces for 2015
The slide show provides an initial look at the deductibles for medical care and the specific deductibles applied to prescription drugs for the plans offered in the federally facilitated and partnership Marketplaces for 2015 operating with healthcare.gov.
Web Briefing for Journalists: Consumer Issues Ahead of the Affordable Care Act’s Second Open Enrollment Season
The Affordable Care Act’s second annual open enrollment period starts Nov. 15 and runs until Feb. 15 — a three-month window for Americans to shop for and purchase new health coverage, or change their plan through Healthcare.gov or their state-run insurance marketplace. This year’s open enrollment season poses both new…