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Claims Denials and Appeals in ACA Marketplace Plans

Based on an analysis of transparency data released by the Centers for Medicare and Medicaid Services (CMS), this brief assess claims denials and appeals among issuers offering individual market coverage on healthcare.gov and finds that 17% of in-network claims were denied by issuers in 2019, with denial rates for specific issuers varying significantly around this average, from less than 1% to more than 50%. Consumers appealed less than 1% of denied claims.

Get Ready for a Lot of Biden Executive Orders on Health Care

In this column for the JAMA Health Forum, Larry Levitt explores what President-elect Biden might do to advance his health care vision both through legislation and through executive orders and waivers and demonstrations.

Health Insurer Financial Performance Through September 2020

In this brief, we analyze third quarter data from 2018 to 2020 to examine how insurance markets performed financially through the end of September. Average margins remained relatively high compared to the same point in recent years, suggesting many insurers remained profitable even as non-COVID-related care returned in the summer and fall.

Millions of Uninsured Americans are Eligible for Free ACA Health Insurance

Amid the ongoing pandemic and high unemployment, this poste xamines how many uninsured people would be eligible for free health insurance during in a typical year, including those who qualify for Medicaid or for tax credits that cover the full cost of an ACA Marketplace plan.

Insurer Participation on the ACA Marketplaces, 2014-2021

For the third straight year, more insurers are entering the ACA Marketplaces or expanding their service area in 2021, creating more choices for consumers shopping for coverage during the 2021 open enrollment period.

How ACA Marketplace Premiums Are Changing by County in 2021

Premiums for ACA Marketplace benchmark silver plans are decreasing on average across the U.S. in 2021. However, premium changes vary widely by location and by metal level, including premium increases in a number of counties and plans.

10 Reasons to Pay Attention to ACA Open Enrollment This Year

Whether new to the market or reenrolling, everyone who wants 2021 coverage through the ACA Marketplace must sign up during Open Enrollment. Here, we detail ten ways in which the 2021 ACA open enrollment period differs from enrollment periods in past years.

The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

www.kff.org | Email Alerts: kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/kff

Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.