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This analysis finds that the ACA’s maximum out-of-pocket limit is likely to grow faster than wages and salaries, and is also expected to grow faster than the maximum out-of-pocket limit for Health Savings Account (HSA)-qualified health plans.
Medicare Part D, the outpatient prescription drug benefit for Medicare beneficiaries, provides coverage above a catastrophic threshold for high out-of-pocket drug costs, but there is no cap on total out-of-pocket drug costs that beneficiaries pay each year. Recent legislative proposals would add a cap on out-of-pocket spending under Part D. This analysis focuses on the potential impact of different out-of-pocket spending caps in terms of how many beneficiaries would be affected and how much they…
This report presents findings from an analysis of the Medicare Part D marketplace in 2012 and changes in drug coverage and costs since 2006. It presents key findings related to Medicare drug plan plan availability, premiums, cost-sharing, the coverage gap and availability for low-income beneficiaries, the coverage gap, benefit design and cost sharing, formularies, and utilization management, based on data from CMS for all plans participating in Part D. The analysis was conducted jointly by…
In this animated video, the YouToons get ready for Obamacare and explore health insurance changes under the Affordable Care Act. This cartoon serves as a health reform tutorial for consumers and organizations.
A new Kaiser Family Foundation report released today finds how health insurance carriers are interpreting and implementing the Affordable Care Act's contraceptive coverage requirement varies, limiting contraceptive options for some women. The ACA requires most private health insurance plans to cover a range of preventive services for women, including prescribed FDA-approved contraceptives and services without cost sharing. The report reviews how health carriers are applying medical management limitations to contraceptive coverage that affect women’s contraceptive…
In 2020, more than 22 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 data note provides an overview of the Medicare Advantage plans that will be available in 2020, 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…
A new issue brief looks at the prevalence of potential surprise medical bills based on patient diagnosis, emergency visits, and type of inpatient admission.
While most people in the U.S. get health insurance through their employer, about 14 million people under age 65 have coverage through the non-group or individual market, which has faced scrutiny recently in news reports about some insurers’ steep rate increases and in the market reforms in the new health reform law that will take effect in 2014. This survey provides insight into the current state of the non-group market and finds policyholders report that…
This primer on health care spending in the United States reviews the growth in health care spending since 1970 and the impact of health care costs on families and employers.
In an effort to simplify Medicare’s cost-sharing requirements, provide beneficiaries with catastrophic protection, and achieve program savings, some have proposed to restructure Medicare’s benefit design. Several recent proposals would create a unified deductible for Medicare Parts A and B, simplify cost-sharing requirements above the deductible, and add an annual limit on beneficiary out-of-pocket spending—a benefit feature typical of larger employer plans, but lacking in traditional Medicare. This issue brief describes the options for adding an…
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