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Claims Denials and Appeals in ACA Marketplace Plans

Based on an analysis of transparency data released by the Centers for Medicare and Medicaid Services (CMS), this brief assess claims denials and appeals among issuers offering individual market coverage on healthcare.gov and finds that 17% of in-network claims were denied by issuers in 2019, with denial rates for specific issuers varying significantly around this average, from less than 1% to more than 50%. Consumers appealed less than 1% of denied claims.

Want to protect people with preexisting conditions? You need the full Affordable Care Act.

In this perspective published by the Washington Post, KFF Executive Vice President for Health Policy Larry Levitt explains why the popular Affordable Care Act provisions that ensure people with pre-existing conditions can access affordable health insurance can’t easily be preserved if other related provisions are overturned.

COVID-19 Test Prices and Payment Policy

This analysis examines list prices for COVID-19 testing at the largest hospitals in every state and finds they range widely from $20 to $850. Federal law now requires private insurers to cover COVID-19 tests at no cost to the patient and provides funding for people without health insurance.

Surprise Bills Often Hit in Emergencies

In an Axios column, Drew Altman previews new data highlighting that people with critical health issues are especially vulnerable to these bills. 

300+ FAQs Help Consumers Understand the ACA Marketplaces as Open Enrollment Begins

Ahead of the annual Affordable Care Act (ACA) open enrollment period, the time during which consumers can shop for health plans or renew existing coverage, KFF has updated and expanded its searchable collection of more than 300 Frequently Asked Questions about open enrollment, the health insurance marketplaces and the ACA.…

Pre-Existing Condition Prevalence for Individuals and Families

This analysis estimates that almost 54 million people – or 27% of all adults under 65 —have pre-existing health conditions that would likely have made them uninsurable in the individual markets that existed in most states before the Affordable Care Act. Almost half (45%) of non-elderly families include at least one adult with such a pre-existing condition. The analysis also includes estimates by age, state and gender.

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.