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  • Cost-Sharing Waivers and Premium Relief by Private Plans in Response to COVID-19 (Nov. 2020 Update)

    Issue Brief

    An updated issue brief estimates the number of enrollees in individual and fully-insured group market plans that have waived cost-sharing – out-of-pocket costs including coinsurance, copayments, and deductibles – for COVID-19 treatment. The analysis also estimates the number of enrollees whose insurer is offering various forms of premium payment relief. The updated analysis finds that, as of November 2020, about half (49%) of fully-insured plan enrollees have coverage that waives cost-sharing for COVID-19 treatment through…

  • Questions About Essential Health Benefits

    Perspective

    The Institute of Medicine (IOM) recently issued its long-awaited report on defining the essential health benefits under the Affordable Care Act (ACA). As expected, the committee preparing the IOM report did not recommend which specific services should be covered, but rather discussed what the process should be for defining the essential benefits, which all insurers selling coverage to individuals and small businesses will have to provide beginning in 2014. Somewhat unexpected was their recommendation to set a…

  • Private Insurance Benefits and Cost-Sharing Under the ACA

    Perspective

    The Department of Health and Human Services (HHS) recently released guidance on the two key components that determine the level of protection that private insurance plans will provide to consumers under health reform. The first involves the services that insurance plans must cover, and the second involves how much patients must pay out-of-pocket for those services. The Affordable Care Act (ACA) establishes new rules for what insurers must provide for both components starting in 2014.…

  • Standard Medicare Prescription Drug Benefit, 2013

    Feature

    Standard Medicare Prescription Drug Benefit, 2013 Download Source Kaiser Family Foundation illustration based on CMS standard benefit parameter update for 2013.  Amounts rounded to nearest dollar.

  • Managing Medicaid Pharmacy Benefits: Current Issues and Options

    Report

    This report examines reimbursement, benefit management and cost sharing issues in Medicaid pharmacy programs. The analysis, conducted by researchers from the Foundation's Kaiser Commission on Medicaid and the Uninsured and Health Management Associates, focuses on the potential of several measures recently highlighted by Health and Human Services Secretary Kathleen Sebelius to reduce Medicaid pharmacy costs and is informed, in part, by the perspectives of a group of Medicaid pharmacy administrators convened by the Foundation in…

  • Medicaid Managed Care in the Era of Health Reform – Briefing and Panel Discussion

    Event Date:
    Event

    Amid increasing state and national interest in using managed care delivery models for Medicaid beneficiaries, the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) hosted a public briefing on Tuesday, June 25, 2013 to provide information on recent transitions from fee-for-service to managed care, and to discuss their implications for care access and delivery. Moderated by Diane Rowland, Executive Vice President of the Foundation and Executive Director of the KCMU, the briefing began…

  • Medicaid Expansion through Premium Assistance: Key Issues for Beneficiaries in Arkansas’ Section 1115 Demonstration Waiver Proposal

    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.