HealthCare.gov insurers denied nearly one out of every five claims (19%) submitted for in-network services and an even larger share (37%) share of claims for out-of-network services in 2023, a new KFF analysis finds. The analysis examines the main source of publicly available data on claims denials and appeals for individual-market plans available through the…More
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. Information about the reasons for…
This policy watch provides a short overview of the Department of Health and Human Services (HHS), describing its history, budget, organizational structure and its major programs and responsibilities.
LAS VEGAS — Case manager Bryon Johnson flashed a light into a dark tunnel beneath the glitz of the Las Vegas Strip on a recent fall afternoon. He stepped into an opening in a concrete ditch littered with trash and discarded clothing to search an underground world for his homeless clients. Beneath the Caesars Palace…
ATLANTA — Deegant Adhvaryu completed his parents’ applications for Medicaid and food benefits in June. Then the waiting and frustration began. In July, his parents, Haresh and Nina Adhvaryu, received a letter saying their applications would be delayed, he said. In August, the Adhvaryus started calling a Georgia helpline, he said, but couldn’t leave a…
With the enhanced subsidies for enrollees in ACA Marketplace plans set to expire at the end of 2025, this calculator illustrates how much out-of-pocket premiums would increase if Congress does not extend the subsidies. It shows the projected premium increases based on incomes, zip code, family size and ages based on 2025 ACA Marketplace premiums.
RICHMOND, Vt. — On a warm autumn morning, Roger Brown walked through a grove of towering trees whose sap fuels his maple syrup business. He was checking for damage after recent flooding. But these days, his workers’ health worries him more than his trees’. The cost of Slopeside Syrup’s employee health insurance premiums spiked 24%…
This blog post details ten things to know about the 2025 open enrollment period.
This brief provides an overview of the financial assistance provided under the ACA for people purchasing coverage on their own through health insurance Marketplaces (also called exchanges).
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…