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FAQs: Health Insurance Marketplace and the ACA

This list of more than 300 Frequently Asked Questions (FAQs) covers the Affordable Care Act’s health insurance Marketplace (aka exchange), individual mandate, open enrollment, premiums and more. It provides answers to questions about specific groups, such as young adults, smokers, the uninsured, and non-traditional households.

Tracking Section 1332 State Innovation Waivers

This interactive map shows the status of all Section 1332 waivers requested by states. The Affordable Care Act (ACA) allows states to apply for innovation waivers to alter key ACA requirements in the individual and small group insurance markets and can be used to shore up fragile insurance markets, address unique state insurance market issues, or experiment with alternative models of providing coverage to state residents.

How Affordable are 2019 ACA Premiums for Middle-Income People?

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.

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 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.

Women’s Health Insurance Coverage

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.