Cost Sharing - Research and Data from KFF

Understanding the Impact of Medicaid Premiums & Cost-Sharing: Updated Evidence from the Literature and Section 1115 Waivers

Sep 9, 2021

Issue Brief

Our review of recent literature on premiums and cost-sharing is based on studies and reports published between 2017 and 2021. Our analysis of premiums in post-Affordable Care Act (ACA) Section 1115 waivers (approved under the Obama and Trump administrations) is based on available interim and final waiver evaluations as well as annual and quarterly state data reports posted on Medicaid.gov.

Most private insurers are no longer waiving cost-sharing for COVID-19 treatment

Aug 19, 2021

Issue Brief

This analysis finds nearly three quarters of the largest health plans in each state are no longer waiving enrollees’ cost-sharing requirements for COVID-19 treatment as of August 2021. Insurers largely waived those costs early in the pandemic, before safe and effetive vaccines were available.

Millions of Medicare Part D Enrollees Have Had Out-of-Pocket Drug Costs High Enough to Exceed the Catastrophic Threshold Over Time

Jul 23, 2021

News Release

Nearly 3 million Medicare Part D enrollees had out-of-pocket drug spending above the catastrophic threshold in a recent five-year period, finds a new KFF analysis that takes a comprehensive look at how many people on Medicare have drug expenses high enough to push them above that limit. While the Part D drug benefit has helped make drugs more affordable for people with Medicare, the lack of a hard cap on annual out-of-pocket spending under Part…

Millions of Medicare Part D Enrollees Have Had Out-of-Pocket Drug Spending Above the Catastrophic Threshold Over Time

Jul 23, 2021

Issue Brief

Medicare Part D, the outpatient prescription drug benefit for Medicare beneficiaries, provides catastrophic coverage for high out-of-pocket drug costs, but there is no limit on the total amount that beneficiaries have to pay out of pocket each year. Policymakers on both sides of the aisle support proposals to modify the design of the Part D benefit and establish a hard cap on out-of-pocket prescription drug spending by Part D enrollees. This analysis shows the number…

How Might the FDA’s Approval of a New Alzheimer’s Drug Impact Medicaid?

Jul 13, 2021

Issue Brief

The brief examines the potential impact of Aduhelm, a newly approved drug for Alzheimer's disease, on state and federal Medicaid costs and looks at potential policy actions that could limit Medicaid’s potential costs.

Poll: Few are Aware of Hospital Price Transparency Requirements

Jun 28, 2021

News Release

Few Americans realize that starting this year hospitals are required to post prices of common health services on their websites in a format patients can access and use, data from the KFF Health Tracking poll shows. Federal regulations that took effect January 1 require this price transparency for hospitals to allow patients to compare prices across hospitals and “shop” for lower-price care. The new survey data finds that 9% of adults nationwide are aware that…

Few Adults Are Aware of Hospital Price Transparency Requirements

Jun 28, 2021

Issue Brief

This data note for the Peterson-KFF Health System Tracker shows that few Americans realize that starting this year hospitals are required to post prices of common health services on their websites in a format patients can access and use.

Analysis: Half of Emergency Ambulance Rides Lead to Out-of-Network Bills for Privately Insured Patients

Jun 24, 2021

News Release

About half of emergency ground ambulance rides result in an out-of-network charge for people with private health insurance, potentially leaving patients at risk of getting a surprise bill, a new KFF analysis for the Peterson-KFF Health System Tracker finds. Congress last year enacted the “No Surprises Act,” which prohibits most surprise out-of-network bills when a patient receives out-of-network services during an emergency visit or at an in-network hospital without advance notice starting in 2022. However,…

Ground Ambulance Rides and Potential for Surprise Billing

Jun 24, 2021

Issue Brief

This analysis for the Peterson-KFF Health System Tracker finds that half of emergency ground ambulance rides result in an out-of-network charge for people with private health insurance, potentially leaving patients at risk of getting a surprise bill.

Although Their Share of the Market Varies By State, Enrollment in Medicare Advantage Plans Has More Than Doubled Over the Past Decade, with More than 4 in 10 Medicare Beneficiaries Now Enrolled in the Private Plans

Jun 21, 2021

News Release

The private plans known as Medicare Advantage now cover more than 4 in 10 Medicare beneficiaries, reflecting a more than doubling of enrollment over the past decade even as the plans remain a far larger presence in some states than others, according to a new KFF analysis. More than 26 million of the nation’s nearly 63 million Medicare beneficiaries are enrolled in Medicare Advantage plans in 2021. The share varies considerably by state, ranging from…

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