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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This 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 also discusses a variety of state and federal proposals that seek to lower premiums for middle-class people buying their own insurance who are ineligible for ACA subsidies.
Analysis: Marketplace Plans Denied an Average of Nearly One in Five Claims in 2017 with Wide Variations across Insurers
Healthcare.gov marketplace insurers denied nearly one out of every five claims (19%) submitted for in-network services in 2017, and enrollees only appeal a tiny share (0.5%) of those denied claims, a KFF analysis of recently released claims data finds. The analysis finds a huge variation across insurers, with average denial…
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 19% of in-network claims were denied by issuers in 2017, with denial rates for specific issuers varying significantly around this average, from less than 1% to more than 40%. Consumers appealed less than 1% of denied claims.
This factsheet reviews major sources of coverage for women residing in the U.S. in 2017, discusses the impact of the ACA on women’s coverage, and the coverage challenges that many women continue to face.
4.2 Million Uninsured People Could Get a Bronze Plan in the ACA Marketplace with $0 Premiums After Tax Credits
We have data on the number and share of uninsured in each state who have access to free bronze plans.
This analysis looks at how many of the remaining uninsured are eligible for premium subsidies that are large enough to cover the entire cost of a bronze plan, which is the minimum level of coverage available on the Marketplaces. It estimates 27% of uninsured individuals who could shop on the ACA Marketplace, or 4.2 million people nationwide, are eligible to purchase a bronze plan with $0 premiums after subsidies in 2019.
This analysis documents average deductibles and out-of-pocket limits for 2019 Affordable Care Act marketplace plans available on Healthcare.gov on all metal tiers, including silver plans after cost-sharing reductions are applied.
Karen Pollitz answers three questions on the Trump administration’s recent changes to the ACA Section 1332 state innovation waiver guidelines and the implications for consumers and state marketplaces in our new “Ask KFF” feature.