New KFF polling explores the challenges beyond costs that people with insurance face in navigating the health care system. People cite prior authorization review as their top problem by a wide margin, with a third saying prior authorization requirements are a “major burden.

Medicare Advantage insurers made nearly 53 million prior authorization determinations in 2024, up from 49.8 million in 2023. They fully or partially denied 7.7% of the prior authorization requests they received. Just 11.5% of all denials were appealed, and the initial denial was overturned in most of those cases.

This brief examines state policies related to prior authorization processes in Medicaid managed care and includes findings about how states approach prior authorization decision timeframes, electronic denial notices, and access to external medical reviews, all as of July 1, 2024.

This brief examines the final CMS regulations governing prior authorization in Medicare Advantage, Marketplace, Medicaid, and other plans, how they might address some current consumer concerns, and some issues that remain.

Proposed updates to federal mental health parity rules would make wide ranging changes to current standards that apply to private insurance and coverage provided by most employers. This issue brief focuses on a requirement that plans perform an “outcome analysis."

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.

The Supreme Court decision overturning “Chevron deference” has profound implications for health care.
It ushers in an era in which courts will not have to accept agency expertise in their review of challenged federal regulations.

This brief analyzes federal transparency data released by the Centers for Medicare and Medicaid Services (CMS) on claims denials and appeals for non-group qualified health plans (QHPs) offered on HealthCare.gov in 2023. It finds that HealthCare.gov insurers denied nearly one out of every five claims (19%) submitted for in-network services.