Cost Sharing

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.

The Centers for Medicare & Medicaid Services (CMS) recently announced the drugs selected for the second round of negotiation for the Medicare Drug Price Negotiation Program, which was established by the Inflation Reduction Act. These FAQs address several questions related to Medicare’s drug price negotiation program and CMS’s implementation of the program, with a focus on the details that apply for 2027, the second year that negotiated prices will be available under the program.

In his Beyond the Data column, KFF President and CEO Drew Altman discusses how how family health coverage is no longer affordable for workers at small employers, contributing to the health cost crisis affecting the American people.

This analysis examines the share of new mothers who have significant medical debt (in excess of $250), compared to other young women who did not recently give birth, using data from the Survey of Income and Program Participation (SIPP).

This analysis documents average deductibles for Affordable Care Act Marketplace plans available on Healthcare.gov for all metal tiers, including silver plans after cost-sharing reductions are applied, for 2014 – 2024, as well as average out-of-pocket limits for silver-level Marketplace plans.

This brief examines key facts around proposals to align Medicare payments for outpatient services across care settings, otherwise known as “site-neutral payment reforms.”

This brief analyzes 2024 Medicare Part D enrollment, premiums, and cost sharing. The analysis highlights the continued growth in Medicare Advantage enrollment in the Part D marketplace and substantially higher average monthly premiums for stand-alone Part D drug plan coverage. Changes to the Part D benefit included in the Inflation Reduction Act are helping to lower out-of-pocket costs for patients but could also contribute to higher-priced Part D coverage.

This brief describes Medicare coverage of sexual and reproductive health services, including contraception, and compares that coverage with private insurance plans and Medicaid. These benefits are particularly relevant to nearly 1 million women of reproductive age (20-49) who are eligible for Medicare due to having a long-term disability.