Cost Sharing - Research and Data from KFF

After the COVID-19 Public Health Emergency Ends on May 11, Some Consumers Could Face High Prices for COVID-19 Testing

May 8, 2023

News Release

After the public health emergency ends on May 11, private health plans will no longer be required to cover the full cost of COVID-19 tests ordered or administered by a clinician or to reimburse consumers for at-home rapid tests. To estimate what consumers might have to pay for tests, KFF’s new analysis draws on claims data showing what private insurers have paid for different types of COVID-19 tests, as well as hospitals’ published “self-pay” prices…

Prices for COVID-19 Testing

May 8, 2023

Issue Brief

This analysis examines the potential costs for COVID-19 testing that some consumers may face once the COVID-19 public health emergency ends on May 11, 2023., depending on whether they have insurance and how their insurance covers testing.

Standardized Plans in the Health Care Marketplace: Changing Requirements

May 8, 2023

Issue Brief

This brief examines the evolving requirements for insurers on HealthCare.gov to offer standardized plans that follow set cost sharing rules for covered benefits in addition to other plans they might offer. It also reviews how some state-run marketplaces have used standardized plans to limit cost sharing for insulin, mental health care, and other services.

Presentation: The End of the Public Health Emergency Declaration for COVID-19

Apr 26, 2023

Feature

Jen Kates, Senior Vice President and Director of KFF’s Global Health & HIV Policy program presented “The End of the Public Health Emergency Declaration for COVID-19,” at the 2023 Preparedness Summit on April 24.

Changes to Medicare Part D in 2024 and 2025 Under the Inflation Reduction Act and How Enrollees Will Benefit

Apr 20, 2023

Issue Brief

The Inflation Reduction Act of 2022 includes several provisions to lower prescription drug costs for people with Medicare and reduce drug spending by the federal government, including a number of changes to the Medicare Part D drug benefit. This brief provides an overview of the Part D benefit design and Part D enrollee cost-sharing requirements in 2023 and changes coming in 2024 and 2025.

How Have Costs Associated With Obesity Changed Over Time?

Mar 24, 2023

Issue Brief

This analysis finds that, among people with large employer health plans, those with an obesity diagnosis on average have higher total and out-of-pocket spending than those without an obesity diagnosis. It also examines the cost of common surgical and pharmacological treatments for obesity.

As the Courts Weigh the Future of the ACA’s Preventive Services Coverage, a New Analysis Shows that Most People with Private Insurance Received At Least One of Those Benefits in 2018

Mar 20, 2023

News Release

The provision of the Affordable Care Act (ACA) that requires most private health plans to cover many preventive services without any cost-sharing for their enrollees is being challenged in federal court. The U.S. District Court in the Northern District of Texas in September concluded that aspects of the requirement were unconstitutional and violated religious rights but has allowed the provision to remain in effect while it considers a remedy. As the courts consider the ACA’s…

Preventive Services Use Among People with Private Insurance Coverage

Mar 20, 2023

Issue Brief

This analysis of claims data estimates that six in ten people with private health insurance - or about 100 million people - used at least one preventive service covered without any out-of-pocket costs through a provision of the Affordable Care Act (ACA) in a typical year prior to the COVID-19 pandemic (2018). The provision that requires most private health plans to cover many preventive services without any cost-sharing for their enrollees is being challenged in…

Many Women Use Preventive Services, but Gaps in Awareness of Insurance Coverage Requirements Persist: Findings from the 2022 KFF Women’s Health Survey

Feb 22, 2023

Issue Brief

This brief presents findings from the 2022 KFF Women’s Health Survey on women’s receipt of cancer screenings and other preventive services and differences between subgroups of women. We also present data on women’s and men’s awareness of federal requirements for private insurance coverage of preventive services.

The Commercialization of Covid Vaccines Is Coming. Here’s What It Means.

Feb 18, 2023

Perspective

In this commentary for Barron's, KFF's Cynthia Cox and Jennifer Kates explore what will happen with costs to COVID-19 vaccines for people with and without insurance once the relevant public health emergency ends on May 11.

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