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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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  • Recent and Anticipated Actions to Reverse Trump Administration Section 1557 Non-Discrimination Rules

    Issue Brief

    The Biden Administration has started taking steps to reverse Trump Administration policy and regulations that significantly narrowed the implementation and administrative enforcement of Section 1557, the Affordable Care Act’s nondiscrimination provision, particularly as the regulations apply to gender identity and sexual orientation. In addition, several lawsuits challenging the regulations, which were initially issued by the Obama Administration and later substantially revised by the Trump Administration, are pending. Section 1557 prohibits discrimination based on race, color,…

  • COVID-19 Test Prices and Payment Policy

    Issue Brief

    This analysis examines list prices for COVID-19 testing at the largest hospitals in every state and finds they range widely from $20 to $850. Federal law now requires private insurers to cover COVID-19 tests at no cost to the patient and provides funding for people without health insurance.

  • Pre-existing Conditions: What Are They and How Many People Have Them?

    Policy Watch

    Facing a challenge now before the Supreme Court, the Affordable Care Act (ACA) included provisions to protect people with pre-existing conditions from discrimination in the individual employment market. This post explains what pre-existing conditions are and the different estimates for the number of people who have them.

  • Surprise Bills Often Hit in Emergencies

    From Drew Altman

    In an Axios column, Drew Altman previews new data highlighting that people with critical health issues are especially vulnerable to these bills. 

  • 300+ FAQs Help Consumers Understand the ACA Marketplaces as Open Enrollment Begins

    News Release

    Ahead of the annual Affordable Care Act (ACA) open enrollment period, the time during which consumers can shop for health plans or renew existing coverage, KFF has updated and expanded its searchable collection of more than 300 Frequently Asked Questions about open enrollment, the health insurance marketplaces and the ACA. Designed to help consumers and the navigators, brokers and others who assist them, the FAQs cover a wide range of topics including eligibility for subsidies,…