Private Insurance

This blog post details ten things to know about the 2025 open enrollment period.

In this column, KFF President and CEO Drew Altman explores the state of consumer protections in health care and explains why, even with consumer frustration clear, Congress is unlikely to pursue major new health insurance protections but there could be some modest steps.

This report examines the share of doctors participating in the provider networks of Qualified Health Plans (QHPs) offered in the individual market in the federal and state Marketplaces in 2021, and how network breadth affected costs for enrollees.

Drug makers sometimes offer copay coupons to lower consumers’ out-of-pocket costs for their brand-name prescriptions, though how private health plans treat those coupons can substantially limit their value to consumers. This issue brief provides an overview of such copay adjustment programs, stakeholder arguments for and against their use, their prevalence, and federal and state efforts to address them.

On June 28, 2024, the U.S. Supreme Court overturned a longstanding legal precedent that required federal courts to defer to reasonable agency interpretation when statutes are ambiguous. The decision will shift many policy decisions from federal agencies to federal judges, with implications for health policy that will reverberate for years to come. This issue brief examines the decision and assesses what’s ahead.

KFF’s Larry Levitt discusses waning awareness of the Affordable Care Act’s provisions protecting people with pre-existing conditions and examines the Republican Study Committee’s budget proposal, which proposes to repeal the provisions.

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.

This brief discusses the longstanding legal doctrine, Chevron deference, being challenged in two cases before the U.S. Supreme Court and includes examples of what could be at stake for health care consumers should federal courts no longer use this doctrine to address litigation related to federal health regulations. The focus here is on patient and consumer protection regulation, but overturning the Chevron deference would have implications in all areas of health care.

Most patients do not know about the new surprise billing protections and likely also do not know of resources available to seek recourse for incorrect medical bills. This brief provides resources to privately insured patients who receive surprise balance bills and also summarizes relevant policies and how they apply to balance billing.

This analysis examines the experiences of lower income adults with their employer sponsored insurance and finds they were more likely to self-report problems with affordability, enrollment, and network adequacy, and to experience negative health consequences as a result of insurance problems, compared to their higher income peers.