Health Reform

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Claims Denials and Appeals in ACA Marketplace Plans in 2020

This analysis of transparency data released by the Centers for Medicare and Medicaid Services (CMS) finds that 18% of in-network claims were denied by healthcare.gov marketplace insurers in 2020, with denial rates varying widely from less than 1% to more than 80%. Consumers appealed just over one-tenth of 1% of those denied claims.

Examining Prior Authorization in Health Insurance

This post explains what’s known about how insurers use prior authorization as a tool to control costs and encourage cost-effective care, the state and federal laws that govern it, and ongoing policy debates over efforts to impose standards to limit or regulate its use.

For ACA Enrollees, How Much Premiums Rise Next Year is Mostly up to Congress

Most customers with coverage through Affordable Care Act’s marketplaces will face big premium increases next year if Congress doesn’t extend the temporary enhanced tax credits included in the American Rescue Plan Act (ARPA) of 2021. If the outcome isn’t clear by summer, fall open enrollment could be a mess.

Strategies To Lower Drug Costs Top the Public’s Health Priorities for Congress

Against the backdrop of public concern about inflation and rising gas prices, proposals to lower what people pay out-of-pocket for drugs tops the public’s list of health care priorities for Congress, a new KFF Health Tracking Poll finds. Most (55%) of the public say inflation is the biggest problem facing…

Out-of-pocket spending on insulin among people with private insurance

This analysis of insurance claims data finds that Congressional proposals to set a $35 per month cap on what people pay out of pocket for insulin would provide financial relief to at least 1 out of 5 insulin users with different types of private health insurance.

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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.