This analysis examines the Department of Health and Human Services (HHS) proposed rule revising the regulations implementing Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination based on race, color, national origin, sex, age, and disability in health programs and activities receiving federal financial assistance. It examines the significant ways that the proposal would narrow the scope of the existing HHS implementing regulations.
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Karen Pollitz, senior fellow for health reform and private insurance at KFF, answers three questions about denied claims and how the federal government may change the data insurers are required to report on this issue.
Analysis: Marketplace Plans Denied an Average of Nearly One in Five Claims in 2017 with Wide Variations across Insurers
Healthcare.gov marketplace insurers denied nearly one out of every five claims (19%) submitted for in-network services in 2017, and enrollees only appeal a tiny share (0.5%) of those denied claims, a KFF analysis of recently released claims data finds. The analysis finds a huge variation across insurers, with average denial…
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 19% of in-network claims were denied by issuers in 2017, with denial rates for specific issuers varying significantly around this average, from less than 1% to more than 40%. Consumers appealed less than 1% of denied claims.
Esta hoja informativa ofrece datos sobre los planes de salud de corto plazo y en qué se diferencian de las pólizas que cumplen con ACA.
A short fact sheet provides information about short-term health insurance policies and how they differ from ACA-compliant plans.
In this June 2018 post for The JAMA Forum, Larry Levitt examines the potential impact of the Trump Administration’s legal challenge to the Affordable Care Act’s protections for people with pre-existing conditions.
A quarter of people in traditional Medicare had private, supplemental health insurance in 2015—also known as Medigap—to help cover their Medicare deductibles and cost-sharing requirements, as well as protect themselves against catastrophic expenses for Medicare-covered services. This issue brief examines implications for older adults with pre-existing medical conditions who may be unable to purchase a Medigap policy or change their supplemental coverage after their initial open enrollment period.
Given the Trump Administration’s promotion of short-term limited-duration (STLD) health insurance policies, this brief examines what they mean for people with HIV. The analysis assesses whether people with HIV could enroll in STLD plans by applying to 38 plans across five states and getting in each case. It also assesses whether such plans could meet basic HIV care and treatment needs for someone diagnosed once enrolled. This finding takes on new importance in light of the Administration’s decision not to defend the ACA and to argue for eliminating pre-existing condition protections.
In this Washington Post op-ed column, Karen Pollitz examines how the Trump Administration’s efforts to promote coverage through short-term health insurance policies, rather than Affordable Care Act coverage, creates trade offs for consumers.