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The Henry J. Kaiser Family Foundation

Private Insurance Benefits and Cost-Sharing Under the ACA

The Department of Health and Human Services (HHS) recently released guidance on the two key components that determine the level of protection that private insurance plans will provide to consumers under health reform. The first involves the services that insurance plans must cover, and the second involves how much patients…

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The Henry J. Kaiser Family Foundation

Insurance Coverage of Contraceptives

In this post, we answer some of the key questions about the new contraceptive coverage policy generally, and more specifically, how it will be applied to religious organizations.

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The Henry J. Kaiser Family Foundation

Transparency and Complexity

This fall a new rule takes effect requiring all private health plans to offer a uniform, simple to read, summary of benefits and coverage (SBC).  The SBC will provide consumers with standardized information about how plans cover essential health benefits and what coverage limits and cost sharing applies. The SBC…

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The Henry J. Kaiser Family Foundation

Questions About Essential Health Benefits

The Institute of Medicine (IOM) recently issued its long-awaited report on defining the essential health benefits under the Affordable Care Act (ACA). As expected, the committee preparing the IOM report did not recommend which specific services should be covered, but rather discussed what the process should be for defining the essential benefits,…

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The Henry J. Kaiser Family Foundation

An Employer Health Benefits Balance Sheet

There seems to be growing interest in the question of how many employers will keep offering coverage to their full-time employees once the Affordable Care Act (ACA) is fully implemented in 2014, or instead will choose to stop offering coverage and pay a penalty. While there is some good analysis…

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The Henry J. Kaiser Family Foundation

Managing Medicaid Pharmacy Benefits: Current Issues and Options

This report examines reimbursement, benefit management and cost sharing issues in Medicaid pharmacy programs. The analysis, conducted by researchers from the Foundation’s Kaiser Commission on Medicaid and the Uninsured and Health Management Associates, focuses on the potential of several measures recently highlighted by Health and Human Services Secretary Kathleen Sebelius…

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The Henry J. Kaiser Family Foundation

An Analysis of the Share of Medicare Beneficiaries Who Would Benefit from an Annual Out-of-Pocket Maximum under Traditional Medicare Over Multiple Years

This analysis examines the share of Medicare beneficiaries who would be helped over time if the program were to add a limit on out-of-pocket spending to traditional Medicare. This analysis was conducted jointly with the Medicare Payment Advisory Commission (MedPAC) in response to a request made during a Feb. 26, 2013 hearing of the House Ways and Means’ Subcommittee on Health.

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The Henry J. Kaiser Family Foundation

Explaining Health Reform: Benefits and Cost-Sharing for Adult Medicaid Beneficiaries

This brief provides details of the benefit and cost-sharing rules that will govern the coverage available under health reform to these newly eligible adults Medicaid beneficiaries, and it identifies key considerations for state policymakers making Medicaid benefit design choices.

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The Henry J. Kaiser Family Foundation

Testimony: Rethinking Medicare’s Benefit Design: Opportunities and Challenges

Foundation Senior Vice President Tricia Neuman testified June 26, 2013 before the House Energy and Commerce Committee Subcommittee on Health about Medicare’s benefit design, and the implications of possible changes for beneficiaries, other stakeholders, and program spending.

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The Future of Medicare Advantage: Are We on the Right Path?

This June 10 briefing looked at Medicare Advantage and changes affecting it, including revised calculations of payments from CMS, and the Affordable Care Act’s reduced payments to Medicare Advantage plans. Speakers discussed how Medicare Advantage plans are expected to respond to payment changes; if quality bonus payments created significant changes in patient care or plan choices; and what implications could these decisions have on beneficiaries with regard to premiums, benefits and more.

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