Cost Sharing Requirements Could Have Implications for Medicaid Expansion Enrollees With Higher Health Care Needs June 27, 2025 Issue Brief This brief uses 2021 Medicaid claims data to examine utilization among Medicaid expansion adults and estimate how much cost sharing these enrollees could be required to pay under the new requirement if all states imposed the maximum cost sharing amounts. This is an illustrative analysis intended to describe which enrollees may be subject to the most cost sharing under the new provisions rather than estimate exactly what expansion enrollees may actually pay.
Explaining Cost-Sharing Reductions and Silver Loading in ACA Marketplaces June 26, 2025 Blog The House of Representatives recently passed a budget reconciliation bill that would appropriate funding for cost-sharing reductions that insurers are required to provide to low-income enrollees in the Affordable Care Act marketplace. This policy watch explains what these cost-sharing reductions are, how they relate to federal spending, and what effect appropriating funding might have on premiums and the uninsured rate.
Make American Health Care Affordable Again June 5, 2025 Perspective In this JAMA Health Forum column, Larry Levitt highlights how the Make America Healthy Again agenda aimed at chronic disease does little to address the affordability of health care and that efforts to lower federal spending on health care may worsen the problem, raising out-of-pocket costs for many people with…
Deductibles in ACA Marketplace Plans, 2014-2025 May 28, 2025 Issue Brief This analysis documents average deductibles for Affordable Care Act Marketplace plans available on Healthcare.gov in 2025 for all metal tiers, including silver plans after cost-sharing reductions are applied, as well as trend data since 2014.
Annual Updates on Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and CHIP April 1, 2025 Report Since 2000, KFF’s Program on Medicaid and the Uninsured has issued regular updates examining changes and trends in the eligibility rules, enrollment and renewal procedures and cost-sharing practices in Medicaid and CHIP. Those reports are compiled here.
Navigating the Maze: A Look at Patient Cost-Sharing Complexities and Consumer Protections March 28, 2025 Issue Brief This brief focuses on consumers’ understanding of health insurance costs and examines existing federal protections that seek to address barriers to understanding the cost of coverage and care, such as price transparency, self-service price estimator tools, and simplifying cost-sharing designs.
New Rule Proposes Changes to ACA Coverage of Gender-Affirming Care, Potentially Increasing Costs for Consumers March 24, 2025 Issue Brief This brief examines a proposed rule that seeks to change how ACA plans would cover gender affirming care services. If finalized the rule could lead insurers to drop coverage or shift costs to individuals and states, making access to gender affirming care more difficult.
A Backlash Against Health Insurers, Redux March 13, 2025 Perspective In this JAMA Health Forum post, Executive Vice President Larry Levitt recalls the mid-1990s’ public backlash against Health Maintenance Organizations (commonly known as HMOs) – all of which preceded the recent outpouring of health insurance concerns – as well as how consumer protections against coverage restrictions have evolved and fallen short.