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Kaiser Family Foundation

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…

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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 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.

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Kaiser Family Foundation

Para consumidores que estén considerando planes de salud de corto plazo…

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.

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Kaiser Family Foundation

JAMA Forum: What Does it Mean to Protect People with Preexisting Conditions?

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.

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Medigap Enrollment and Consumer Protections Vary Across States

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.

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Short-Term Limited Duration Plans and HIV

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.

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Kaiser Family Foundation

Yes, the Trump administration promotes consumer choice — for healthy people

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.

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Kaiser Family Foundation

Analysis: Most Short-Term Health Plans Don’t Cover Drug Treatment or Prescription Drugs, and None Cover Maternity Care

A new Kaiser Family Foundation analysis of short-term, limited duration health plans for sale through two major national online brokers finds big gaps in the benefits they offer. Through an executive order and proposed new regulations, the Trump Administration is seeking to encourage broader use of short-term, limited duration health…

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Understanding Short-Term Limited Duration Health Insurance

In late 2017, President Trump issued an executive order directing the Secretary of Health and Human Services to take steps to expand the availability of short-term health insurance policies. This brief provides background information on short-term policies and how they differ from ACA-compliant health plans. It also analyzes the short-term plans available through two major online brokers to assess how often they include coverage for mental health, substance abuse, prescription drugs and maternity care.

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Proposals for Insurance Options That Don’t Comply with ACA Rules: Trade-offs In Cost and Regulation

This brief examines four options to promote the sale of health plan options in the individual or non-group market that are not subject to Affordable Care Act (ACA) requirements for other major medical health plans. It reviews the trade-offs involved if such loosely regulated markets take root as an alternative to the ACA-regulated market, particularly as the repeal of the individual mandate penalty takes effect next year.

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The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400
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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.