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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.

Prior Authorization

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  • Update on Individual Health Insurance

    Report

    This report provides information about the individual health insurance market using data from the largest vendor of this type of insurance, eHealthInsurance. The report includes who is buying individual insurance, what they are actually paying for the insurance, and buying patterns. It is the first in an up-coming series of reports jointly produced by the Kaiser Family Foundation and eHealthInsurance to provide trend information in such areas of interest as premiums and cost sharing, and…

  • Retiree Health Benefits in 2003: Employer Survey

    Report

    This survey, conducted by the Kaiser Family Foundation and Hewitt Associates between June and September 2003 provides detailed information on retiree health programs offered by large private-sector employers. The data in this survey reflect the responses of 408 large firms (private-sector employers with 1,000 or more workers) and provides information on eligibility, benefits, premiums, and total cost in 2003, and offers insights as to what changes employers say they are likely to make in the…

  • A Guide to Developing Assistance Programs for Health Care Consumers

    Report

    The Health Rights Hotline, based in Sacramento, California, wasestablished in 1997 as a model to demonstrate and assess how anindependent assistance program can help consumers successfully accesscare, navigate the health care system, and improve the system for allhealth care consumers. Based on the experiences of the Health Rights Hotline, this Guideprovides a framework and specific steps that organizations may take to set up a consumer assistance program. Areas covered include program design, staffing and training,…

  • Comparisons of the Liability Provisions of the House and Senate Patients’ Rights Bills

    Report

    A hotly debated issue in Congress has been the issue of when health maintenance organizations, health insurers, and those who administer health benefit plans should be financially liable to their plan participants for a denial of a claim or for damages for any injuries that result from such denials (known as health plan liability ). This new report by Gary Claxton of the Georgetown Institute for Health Care Research and Policy describes the health plan…

  • How Private Insurance Works: A Primer

    Report

    This primer, prepared by Gary Claxton of the Institute for Health Care Research and Policy at Georgetown University, examines the structure and operation of private health insurance including the types of organizations that provide it, how managed care is delivered, and how risk pools work and describes how private health insurance coverage is regulated under state and federal laws. The primer explains how the current nature of private insurance relates to key issues facing federal…

  • Pieces of the Puzzle

    Report

    A new report describes the Report to Congress by the Department of Health and Human Services on consumer protection and quality assurance requirements for Medicaid managed care and discusses the differences between the original Federal rule and the revised one. Report Executive Summary  

  • Public Opinion Update: The Public, Managed Care, and Consumer Protections

    Fact Sheet

    The Kaiser Family Foundation and Harvard School of Public Health monitored consumer experiences with managed care and attitudes toward alternative consumer protection approaches. This Public Opinion Update summarizes key findings from surveys conducted between 1997 and 2001, a period in which the intensity of public debate and media attention paid to managed care issues varied substantially. Public Opinion Update (PDF)

  • New Survey on Consumer Experiences with Health Plans

    Report

    Survey on Consumer Experiences with Health Plans A Kaiser Family Foundation/Harvard School of Public Health survey found that more than six in ten privately insured American adults under age 65 give their health plans a grade of A or B, but nearly half report having some type of problem with their health plan in the last year with a range of consequences for the consumer. The survey found strong support for the right-to-sue a health…

  • Guide to Federal Patients Bill of Rights Debate

    Report

    This guide, prepared by Stephanie Lewis, JD, MHSA for the Kaiser Family Foundation, explores key issues in the Congressional debate over a federal patients bill of rights.

  • Health News Index – July/August 2001

    Poll Finding

    Health News Index July/August, 2001 The July/August 2001 edition of the Kaiser Family Foundation/Harvard School of Public Health, Health News Index includes questions about major health stories covered in the news, including stem cell research and patients rights legislation. The Health News Index is designed to help the news media and people in the health field gain a better understanding of which health stories Americans are following and what they understand about those health issues.…