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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.

The Language of Health Care Reform

Published in the Jan. 19 edition of JAMA, this article from KFF Executive Vice President for Health Policy Larry Levitt lays out the major health policy challenges that will confront President-elect Biden and potential approaches to major reform. While a big reform debate may not be likely this year, one…

Women’s Health Insurance Coverage

This factsheet reviews major sources of coverage for women residing in the U.S. in 2019, discusses the impact of the ACA on women’s coverage, and the coverage challenges that many women continue to face

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.

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.

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.

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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.