Explaining Health Care Reform: Medical Loss Ratio (MLR) February 29, 2012 Fact Sheet This fact sheet explains the Medical Loss Ratio requirement under the Affordable Care Act (ACA). The MLR provision limits the portion of premium dollars health insurers may spend on administration, marketing, and profits. Under health care reform, health insurers must publicly report the portion of premium dollars spent on health care and quality improvement and other activities in each state they operate. Insurers failing to meet the applicable standard must pay rebates to consumers and businesses.
Medicaid Expansion through Premium Assistance: Key Issues for Beneficiaries in Arkansas’ Section 1115 Demonstration Waiver Proposal July 19, 2013 Issue Brief This issue brief provides background about Medicaid premium assistance in the individual health insurance market, summarizes major components of Arkansas’ Section 1115 demonstration waiver application to implement the Affordable Care Act’s Medicaid expansion through premium assistance, and considers key issues affecting beneficiaries.
Survey of Health Insurance Marketplace Assister Programs July 15, 2014 Report This survey by the Kaiser Family Foundation of Navigators and other Marketplace consumer assistance programs under the Affordable Care Act (Obamacare) offers a nationwide analysis of the number and distribution of assisters and people they helped. The report examines the experience of programs in conducting outreach and enrollment assistance during the first open enrollment period. It also reviews the nature of help consumers needed applying for Medicaid or premium tax credits and understanding health insurance choices, and discusses key factors that impacted the effectiveness of Marketplace Assister Programs.
JAMA Forum: A To-Do List for the New CEO of the Federal Health Insurance Marketplace September 3, 2014 Perspective Larry Levitt’s July 2014 post at the JAMA Forum assesses early indications of how well the Affordable Care Act is working.
Connecting Consumers to Coverage: Lessons Learned from Assisters for Successful Outreach and Enrollment September 19, 2014 Issue Brief This brief highlights the experiences of Navigators and other Marketplace consumer assistance programs under the Affordable Care Act (Obamacare) in conducting outreach and providing enrollment assistance during the ACA’s first open enrollment period. It provides insight into the outreach and enrollment strategies the assisters developed and identifies the keys to successfully overcoming the challenges of the first year. These insights are based on findings from focus groups with assisters in four cities: Miami, Florida; Houston, Texas; Raleigh, North Carolina; and Cleveland, Ohio.
Pre-existing Conditions: What Are They and How Many People Have Them? October 1, 2020 Blog Facing a challenge now before the Supreme Court, the Affordable Care Act (ACA) included provisions to protect people with pre-existing conditions from discrimination in the individual employment market. This post explains what pre-existing conditions are and the different estimates for the number of people who have them.
No Surprises Act Implementation: What to Expect in 2022 December 10, 2021 Issue Brief The “No Surprises Act,” which establishes new federal protections against most surprise out-of-network medical bills when a patient receives out-of-network services during an emergency visit or from a provider at an in-network hospital without advance notice, will take effect next month. A new KFF brief outlines what to expect in 2022.
‘In Focus with KFF’: What to Know About the New Ban on Surprise Bills January 5, 2022 Video In this new video, KFF Senior Fellow Karen Pollitz explains why surprise bills have been such a major problem for patients, the new federal ban on the practice, and how patients can get help if they received a surprise bill.
Before New Ban, the Prevalence of Surprise Bills January 7, 2022 Slide Patients with certain conditions appear to be at higher risk for receiving surprise bills. They should be aware of new federal protections against surprise bills and know how to seek out help if they have improperly received one.
Network Adequacy Standards and Enforcement February 4, 2022 Issue Brief Health plan networks affect patient access to care. This brief reviews options for setting and enforcing network adequacy standards and tools for making differences in plan networks more transparent.