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  • Premiums for Employer-Sponsored Family Health Coverage Rise Slowly for Sixth Straight Year, Up 3% but Averaging $18,764 in 2017

    News Release

    Workers Covered By Smaller Firms Pay More Toward Family Premiums and in Cost Sharing Than Those in Larger Ones Menlo Park, Calif. – Annual family premiums for employer-sponsored health insurance rose an average of 3 percent to $18,764 this year, continuing a six-year run of relatively modest increases, according to the benchmark Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2017 Employer Health Benefits Survey released today. This year’s premium increase is similar to the rise in…

  • Medicare Advantage 2019 Spotlight: First Look

    Issue Brief

    In 2019, more than 20 million Medicare beneficiaries (34%) are enrolled in Medicare Advantage plans, which are mainly HMOs and PPOs offered by private insurers as an alternative to the traditional Medicare program. This issue brief provides an overview of the Medicare Advantage plans that will be available in 2019, including the variation in the number of plans available by county and plan type. The brief also examines the insurers entering the Medicare Advantage market…

  • 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…

  • The Budget Trigger and Health Reform

    Perspective

    No doubt it will take some time to sort out how elements of the debt deal (formally "The Budget Control Act of 2011") will all work. Delving into the details of how it affects subsidies in the Affordable Care Act (ACA) to make insurance more affordable helps to illustrate how complex this business can be. Let's start with a short primer on the ACA subsidies. Starting in 2014 people buying insurance on their own in…

  • 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.…

  • Betting on Private Insurers

    Perspective

    Just-released estimates of national health spending in 2010 by the Centers for Medicare and Medicaid Services (CMS) show that 45% of our health care spending is financed by the federal and state governments, primarily through the Medicare and Medicaid programs. This share has grown temporarily in recent years because of the economic downturn, as private insurance has declined and Medicaid has grown. It has also increased due to our demographic destiny: the growing cohort of baby…

  • Getting into Gear for 2014: Briefing, Survey Examine 2013 Data From 50-State Survey of Medicaid and CHIP Eligibility and Enrollment Policies

    Event Date:
    Event

    Following the Supreme Court ruling upholding the Affordable Care Act (ACA) and as 2014 approaches, many states are moving into high gear to prepare for implementation of the major provisions of the law, including a new streamlined Medicaid enrollment system and, at states' option, the expansion of Medicaid. Nearly all states are pressing forward with information technology and process improvements to develop faster, streamlined Medicaid enrollment systems as required under the ACA, whether or not…

  • Premiums and Cost-Sharing in Medicaid

    Issue Brief

    Medicaid, the nation’s public health insurance program for low-income people, now covers nearly 60 million Americans, including many working families, low-income elderly, and individuals with disabilities. Medicaid beneficiaries tend to be poorer and sicker than those enrolled in private insurance. Given these characteristics, federal law limits the extent to which states can charge premiums and cost-sharing, particularly for pregnant women, children and adults but allows flexibility for individuals with incomes above 100% of the federal…