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pre-existing conditions

Pre-Existing Condition Prevalence for Individuals and Families

This analysis estimates that almost 54 million people – or 27% of all adults under 65 —have pre-existing health conditions that would likely have made them uninsurable in the individual markets that existed in most states before the Affordable Care Act. Almost half (45%) of non-elderly families include at least one adult with such a pre-existing condition. The analysis also includes estimates by age, state and gender.

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Data Note: 2019 Medical Loss Ratio Rebates

We estimate insurers will be issuing a total of at least $1.3 billion in MLR rebates across all markets – exceeding the previous record high of $1.1 billion in 2012, due in part to the record profits insurers made in 2018. The amount varies by market, with insurers reporting at least $743 million in the individual market, $250 million in the small group market, and $284 million in the large group market.

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Kaiser Family Foundation

Private Insurers Are Expected to Pay a Record of At least $1.3 Billion in Rebates to Consumers Beginning in September for Excessive Premiums Relative to Health Care Expenses

Private insurance companies are expecting to pay out a record of at least $1.3 billion in rebates to consumers this fall based on their share of premium revenues devoted to health care expenses in recent years, surpassing the previous record high of $1.1 billion in 2012, according to a new…

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Enrollment in Individual Market Dips Slightly in Early 2019 after Repeal of Individual Mandate Penalty

Overall enrollment in the individual market fell 5% to 13.7 million in the first quarter of 2019 following the repeal of the ACA’s individual mandate penalty.

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Data Note: Changes in Enrollment in the Individual Health Insurance Market through Early 2019

This analysis measures changes in enrollment in the individual market, including those in both marketplace plans and off-exchange plans, before and after the ACA’s coverage expansions and market rules went into effect in 2014 through the first quarter of 2019.

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As Policymakers Debate Medicare-for-All, Analysis Finds the Medicare Advantage, Individual and Group Health Insurance Markets Appear to Be Profitable, Especially Medicare Advantage

Three key private health insurance markets — Medicare Advantage, the individual market and the fully-insured group market — appear to be financially healthy and attractive to insurers, according to a new KFF analysis. The private Medicare Advantage market generates significantly larger gross margins per person than the individual market or…

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Financial Performance of Medicare Advantage, Individual, and Group Health Insurance Markets

Three key private health insurance markets — Medicare Advantage, the individual market and the fully-insured group market — appear to be financially healthy and attractive to insurers. The private Medicare Advantage market generates significantly larger gross margins per person than the individual market or fully-insured market. The future of these markets has become a focus for policymakers amid the debate over Medicare for All.

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State Actions to Improve the Affordability of Health Insurance in the Individual Market

A number of states have taken steps to provide consumers with more affordable coverage options in the individual market, including the marketplaces. Some states are implementing strategies that lower premiums by building on, and increasing the stability of the individual market, while other states are expanding the availability of lower cost coverage sold outside the marketplaces that does not comply with ACA standards—an approach that could increase marketplace premiums further. This brief examines these different approaches and discusses the implications of state policy choices.

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Ask KFF

Ask KFF: Karen Pollitz Answers 3 Questions on Why Insurers Deny Claims

Karen Pollitz, senior fellow for health reform and private insurance at KFF, answers three questions about denied claims and how the federal government may change the data insurers are required to report on this issue.

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Kaiser Family Foundation

Among People Ineligible for Subsidies, Middle-Class Older Adults Face the Least Affordable ACA Premiums, Especially Those Living in Rural Areas Where Premiums Are Highest

A new KFF analysis finds that Affordable Care Act marketplace premiums are least affordable for older adults who earn too much to qualify for federal subsidies, especially those living in rural areas where premiums are highest. The analysis of the lowest-cost 2019 ACA marketplace plans across U.S. counties finds that…

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