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In his first column for the new year, KFF CEO Dr. Drew Altman analyzes President Trump’s “make a deal” approach to health care. He explains that while the president doesn’t have a health reform plan, or even “concepts of a plan,” or a replacement for the ACA, he does have a distinctive set of tactics that features one-off deals with the health care industry that are more like “health policy by transaction.” He writes that…
In a new column, President and CEO Dr. Drew Altman forecasts eight things to look for in health policy in 2026. “First and foremost,” he writes, “is the role health care affordability will play in the midterms.” And, he notes: “The average cost of a family policy for employers could approach $30,000 and cost sharing and deductibles will rise again after plateauing for several years.”
Using data from the 23rd KFF survey of officials administering Medicaid home care programs, this issue brief describes the mechanisms states are currently using to limit Medicaid spending on home care and their plans for adopting new mechanisms in state fiscal year (FY) 2026.
Prior authorization review frustrates patients and physicians, but we likely can’t just eliminate it. In his new column, President and CEO Dr. Drew Altman discusses why, and why the focus is now instead on “doing it smarter.” Altman writes: “A proposal to eliminate prior authorization altogether could be the single most tangible and popular health reform idea a candidate could make. But, in our fragmented health system, with no great way to control costs or…
This brief examines state policies related to prior authorization processes in Medicaid managed care and includes findings about how states approach prior authorization decision timeframes, electronic denial notices, and access to external medical reviews, all as of July 1, 2024.
This brief provides information about Medicare Advantage plans in 2025, including premiums, out-of-pocket limits, supplemental benefits, and prior authorization, as well as trends over time.
Following a pledge by insurance companies to reduce the burden of prior authorizations, KFF's Health Tracking Poll examines the publics experience with the process. The poll finds that most view insurers' delays and denials as a problem, and few are aware of the newly announced pledge.
Medicare Advantage plans denied 3.4 million prior authorization requests for health care services in whole or in part in 2022, or 7.4% of the 46.2 million requests submitted on behalf of enrollees that year, according to a new KFF analysis of federal data. That was a higher share of denials than in recent years. The share of all prior authorization requests denied by Medicare Advantage plans increased from 5.7% in 2019, 5.6% in 2020 and…
This brief provides information about Medicare Advantage plans in 2024, including premiums, out-of-pocket limits, supplemental benefits, and prior authorization, as well as trends over time.
This brief examines the final CMS regulations governing prior authorization in Medicare Advantage, Marketplace, Medicaid, and other plans, how they might address some current consumer concerns, and some issues that remain.
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