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The ACA Marketplace Open Enrollment season begins November 1, and with it comes looming changes to the enhanced premium tax credits, increases in out-of-pocket premium payments, new Marketplace eligibility rules, and more. Read our analysis of what these and other changes could mean for new and returning enrollees.
This policy explainer describes what Individual Coverage Health Reimbursement Arrangements (ICHRAs) are and how do they differ from typical employer-sponsored health care plans.
This analysis of preliminary rate filings submitted by 105 ACA Marketplace insurers in 19 states and DC shows that ACA Marketplace insurers are requesting a median premium increase of 15% for 2026, which would represent the largest hike in premiums since 2018, the last time policy uncertainty contributed to sharp premium growth. The scheduled expiration of enhanced tax credits and impact of tariffs on some drugs, medical equipment, and supplies are among the factors pushing premiums higher
This brief estimates the number of current Marketplace enrollees with a mental health diagnosis to understand what changes in enrollment may mean for access to services. Among the 24.3 million Marketplace enrollees in 2025, over 4.4 million individuals are estimated to have at least one mental health diagnosis on a health care claim.
This report is based on 35 structured interviews conducted from January to August 2023, with nearly 80 experts and key players such as pharmacists, health plans, and state Medicaid officials involved in the coverage and provision of OTC contraception in seven states with one or more of these coverage approaches (IL, NJ, NM, NY, OR, UT, and WA). It discusses the challenges and successes in coverage under private health insurance and Medicaid and reviews policy options for operationalizing insurance coverage of non-prescribed OTC contraception such as Opill.
This analysis of insurers' preliminary rate filings shows that ACA Marketplace insurers are requesting a median premium increase of 7% for 2025, similar to the 6% premium increase filed for 2024. Insurers cite growing health care prices – particularly for hospital care – as a key driver of premium growth in 2025.
Using health insurer financial data for 2023, we find that in 2023, per enrollee gross margins were highest in the Medicare Advantage market, and medical loss ratios were lowest in the individual insurance market. Across most markets, gross margins have been relatively stable in recent years.
An analysis of 2022 KFF Women’s Health Survey (WHS) data finds that although large shares of women report needing mental health services over the past two years, a significant percentage did not access services they felt they needed.
Private insurance companies are expecting to pay out $1 billion in rebates to consumers this fall under an Affordable Care Act provision that requires insurers to spend the bulk of customers’ premium payments on care, a new KFF analysis finds. Rebates are based on insurers’ experiences over the previous three years.
A new analysis of health insurers’ financial data suggests that they remained profitable across markets in 2020 due in part to an unprecedented decrease in health spending and utilization in the spring as the COVID-19 pandemic led to massive shutdowns.
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