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Prior Authorization Metrics Provide New Insights into Insurer Practices, but Gaps Remain

This analysis of available 2025 prior authorization data finds insurers denied at least 1 in 8 standard requests for prior authorization across three insurance markets: Medicare Advantage, Medicaid managed care, and the federally facilitated ACA Marketplaces. Denial rates varied wide segments by insurer. The analysis highlights limitations of the data and challenges for consumers interpreting it.

TrumpRx: What’s the Value for Customers?

In February, the Trump administration launched TrumpRx, a government website that provides prescription drug discounts to consumers. This brief examines issues that may impact consumers, especially those with private insurance, who access drug discounts through TrumpRx.

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  • Spending To Survive: Cancer Patients Confront Holes in the Health Insurance System

    Event Date:
    Event

    This report highlights the severe challenges cancer patient may face in paying for life-saving care even when they have private health insurance. Jointly authored by the Kaiser Family Foundation and the American Cancer Society, the report profiles 20 patients and illustrates the potential difficulties people diagnosed with cancer or other serious illnesses have in maintaining affordable health insurance and paying for their health care. The patients in the report and accompanying video were selected to…

  • Cost Sharing for Health Care: France, Germany, and Switzerland

    Issue Brief

    As policymakers in the United States weigh options for reform to the nation’s health care system, the level of cost sharing that consumers face when they receive services covered by their health plans is a major consideration, especially for those with serious health conditions. This background brief authored by Kaiser Family Foundation researchers examines how three European countries – France, Germany, and Switzerland – have dealt with cost sharing in their health systems. While cost…

  • Primers on Key Health Care Topics and Programs

    Issue Brief

    The Kaiser Family Foundation maintains a number of primers providing overviews of key health care programs and issues. Written by Foundation staff, each primer provides key data and information that helps illustrate the topic and its relevance for the nation's health care system. Medicaid: A Primer Medicare: A Primer The Uninsured: A Primer Health Care Costs: A Primer How Private Health Coverage Works: A Primer Mental Health Financing in the United States: A Primer The…

  • How Private Health Coverage Works: A Primer – 2008 Update

    Issue Brief

    How Private Health Coverage Works: A Primer— 2008 Update This primer explains the role and operations of private health coverage in the United States. Private health coverage is provided under a variety of different arrangements, including health insuring organizations regulated under state law and health plans sponsored by employers and employee organizations that operate under the federal Employee Retirement Income Security Act (ERISA). The primer discusses the fundamental aims of private health coverage and sorts out…

  • Nursing Home Reform: Then and Now

    Video

    To mark the 20th anniversary of the passage of landmark federal legislation to improve the quality of nursing home care, the Omnibus Budget Reconciliation Act of 1987 (known as OBRA 87), this video examines the history surrounding the law. The video includes a look at the state of nursing home care before the law, an overview of the legislative process that brought about the law, and recent developments in nursing home quality. The video features…

  • Health Affairs Article: Impact of State Tort Reforms on Physician Malpractice Payments

    Issue Brief

    A study in the March/April 2007 issue of Health Affairs analyzes the impact of state tort reforms on physician malpractice claims. The study finds that the tort law changes have had a measurable but limited impact on physician malpractice claims, depending on the type and strength of the tort reform. Commissioned by Kaiser, the study was authored by Teresa M. Waters of the University of Tennessee, and Peter P. Budetti of the University of Oklahoma, and Gary…

  • A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan

    Report

    Most people get their health care through some form of managed care plan – a health maintenance organization, preferred provider organization, or point-of-service option. Most of the time, people receive the care they need, but the potential exists for disagreements over the services that will be provided or paid for by health plans. Health plans are required to follow state and federal rules for handling their enrollee’s complaints and appeals inside the health plan, known…

  • National Survey on Consumers’ Experiences With Patient Safety and Quality Information

    Poll Finding

    National Survey on Consumers' Experiences With Patient Safety and Quality Information This survey assesses Americans' perceptions about the quality of health care, their awareness and reported usage of information in making their health care choices, and their experiences with their health care providers five years after the Institute of Medicine's landmark report on medical errors. The Kaiser Family Foundation, the Agency for Healthcare Research and Quality and the Harvard School of Public Health collaborated on…

  • National Survey on Consumers’ Experiences With Patient Safety and Quality Information — Summary and Chartpack

    Poll Finding

    National Survey on Consumers' Experiences With Patient Safety and Quality Information -- Summary and Chartpack This chartpack summarizes key findings from a national survey assesses Americans' perceptions about the quality of health care, their awareness and reported usage of information in making their health care choices, and their experiences with their health care providers five years after the Institute of Medicine's landmark report on medical errors. The Kaiser Family Foundation, the Agency for Healthcare Research…

  • National Survey on Consumers’ Experiences With Patient Safety and Quality Information — Toplines

    Poll Finding

    National Survey on Consumers' Experiences With Patient Safety and Quality Information -- Toplines This document includes the complete toplines from a national survey assessing Americans' perceptions about the quality of health care, their awareness and reported usage of information in making their health care choices, and their experiences with their health care providers five years after the Institute of Medicine's landmark report on medical errors. The Kaiser Family Foundation, the Agency for Healthcare Research and…