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Prior Authorization

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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.

Claims Denials and Appeals in ACA Marketplace Plans in 2024

This brief analyzes federal transparency data published by CMS on claims denials and appeals for Marketplace plan offered on HealthCare.gov in 2024, and finds insurers denied 19% of in-network claims. Consumers rarely appeal denied claims.

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  • Health Care Debt In The U.S.: The Broad Consequences Of Medical And Dental Bills

    Report

    The KFF Health Care Debt Survey finds that four in ten adults have some form of health care debt, with most citing one-time or short-term medical expenses as the contributor. Many of those with health care debt report making personal sacrifices and enduring financial consequences as a result of their debt, while nearly one in five think they will never be able to pay off.

  • Examining Prior Authorization in Health Insurance

    Policy Watch

    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.

  • Employer Coverage of Travel Costs for Out-of-State Abortion

    Policy Watch

    This Policy Watch gives an overview of employers offering to cover travel expenses for workers who need to go out of state for an abortion in the context of increasing restrictions on abortion around the country. We discuss who is offering these benefits, the implications for workers, and some of the legal and political concerns for employers.

  • No Surprises Act Quiz

    Feature

    A new federal law provides new consumer protections against "surprise" medical bills beginning this year. Test your knowledge about its provisions with this 12-question quiz.

  • Network Adequacy Standards and Enforcement

    Issue Brief

    Health plan networks affect patient access to care. This brief reviews options for setting and enforcing network adequacy standards and tools for making differences in plan networks more transparent.

  • How are Large Private Insurers Covering At-Home Rapid Tests?

    News Release

    Less than a week after a new federal mandate to cover such products took effect, about half of the nation’s largest private insurers allow enrollees to directly obtain rapid at-home COVID-19 tests from specific sources without having to pay anything upfront, a new KFF analysis finds. The new coverage requirement took effect Jan.

  • How Are Private Insurers Covering At-Home Rapid COVID Tests?

    Policy Watch

    This policy watch provides an early look at how top private insurers are implementing a new requirement to cover the cost of at-home COVID-19 tests. Initially about half offer a direct coverage option and half require an enrollee to pay upfront and then seek reimbursement.

  • Medicaid and At-Home COVID-19 Tests

    Policy Watch

    As COVID cases have surged across the United States due to the new Omicron variant, the Biden Administration has stepped up efforts to expand testing capacity including by making at-home COVID tests more available.

  • Before New Ban, the Prevalence of Surprise Bills

    Feature

    Patients with certain conditions appear to be at higher risk for receiving surprise bills. They should be aware of new federal protections against surprise bills and know how to seek out help if they have improperly received one.