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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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  • 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. 15, just five days after the Biden administration released detailed guidance about implementing the new requirements originally announced on Dec. 2.. The…

  • 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.

  • No Surprises Act Implementation: What to Expect in 2022

    Issue Brief

    The “No Surprises Act,” which establishes new federal protections against most surprise out-of-network medical bills when a patient receives out-of-network services during an emergency visit or from a provider at an in-network hospital without advance notice, will take effect next month. A new KFF brief outlines what to expect in 2022.

  • Poll: Few are Aware of Hospital Price Transparency Requirements

    News Release

    Few Americans realize that starting this year hospitals are required to post prices of common health services on their websites in a format patients can access and use, data from the KFF Health Tracking poll shows. Federal regulations that took effect January 1 require this price transparency for hospitals to allow patients to compare prices across hospitals and “shop” for lower-price care. The new survey data finds that 9% of adults nationwide are aware that…

  • Few Adults Are Aware of Hospital Price Transparency Requirements

    Issue Brief

    This data note for the Peterson-KFF Health System Tracker shows that few Americans realize that starting this year hospitals are required to post prices of common health services on their websites in a format patients can access and use.

  • Analysis: Half of Emergency Ambulance Rides Lead to Out-of-Network Bills for Privately Insured Patients

    News Release

    About half of emergency ground ambulance rides result in an out-of-network charge for people with private health insurance, potentially leaving patients at risk of getting a surprise bill, a new KFF analysis for the Peterson-KFF Health System Tracker finds. Congress last year enacted the “No Surprises Act,” which prohibits most surprise out-of-network bills when a patient receives out-of-network services during an emergency visit or at an in-network hospital without advance notice starting in 2022. However,…

  • Ground Ambulance Rides and Potential for Surprise Billing

    Issue Brief

    This analysis for the Peterson-KFF Health System Tracker finds that half of emergency ground ambulance rides result in an out-of-network charge for people with private health insurance, potentially leaving patients at risk of getting a surprise bill.