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  • What is the Centers for Medicare and Medicaid Services’ New AHEAD Model?

    Issue Brief

    In September 2023, the Centers for Medicare and Medicaid Services (CMS) announced a new opportunity for states to leverage federal funding on health care: the Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. With this model, CMS – under the auspices of the CMS Innovation Center, also known as CMMI -- aims to reduce the rate of growth in health care spending, improve people's health, and reduce disparities in health outcomes. This issue brief…

  • What resources are available for privately insured patients who get surprise balance bills?

    Issue Brief

    Most patients do not know about the new surprise billing protections and likely also do not know of resources available to seek recourse for incorrect medical bills. This brief provides resources to privately insured patients who receive surprise balance bills and also summarizes relevant policies and how they apply to balance billing.

  • How Many People with Employer-Sponsored Insurance Use the Drugs Slated for Medicare Price Negotiations

    Issue Brief

    Among the 167 million people with employer-sponsored insurance in 2022, 3.4 million used at least one of the first 10 drugs identified for Medicare price negotiations, according to a new analysis. The most used drug for people with employer-sponsored health insurance was Jardiance, a drug used to treat diabetes and heart failure, which was taken by more than 911,000 enrollees. The analysis uses the Merative MarketScan 2022 commercial claims to estimate the number of enrollees…

  • Prices for COVID-19 Testing

    Issue Brief

    This analysis examines the potential costs for COVID-19 testing that some consumers may face once the COVID-19 public health emergency ends on May 11, 2023., depending on whether they have insurance and how their insurance covers testing.

  • After the COVID-19 Public Health Emergency Ends on May 11, Some Consumers Could Face High Prices for COVID-19 Testing

    News Release

    After the public health emergency ends on May 11, private health plans will no longer be required to cover the full cost of COVID-19 tests ordered or administered by a clinician or to reimburse consumers for at-home rapid tests. To estimate what consumers might have to pay for tests, KFF’s new analysis draws on claims data showing what private insurers have paid for different types of COVID-19 tests, as well as hospitals’ published “self-pay” prices…

  • Ongoing Challenges with Hospital Price Transparency

    Issue Brief

    This analysis examines transparency data currently shared by hospitals to comply with federal law and finds that they are messy, inconsistent and confusing, making it challenging if not impossible for patients or researchers to use them to compare prices. Many of these shortcomings stem from a lack of specificity in the requirements for what hospitals must report.

  • Analysis: Inconsistencies Within Hospital Price Transparency Data Make Cost Comparisons Difficult

    News Release

    Since 2021, federal law has required hospitals to publicly post information about their standard prices and negotiated discount rates for common health services to encourage consumers to compare prices and to promote competition. To date, however, the transparency data currently shared by hospitals to comply with the law are messy, inconsistent and confusing, making it challenging, if not impossible, for patients or researchers to use them to compare prices across hospitals or payers, a new…