Medicare Advantage Insurers Report Much Higher Gross Margins Per Enrollee Than Insurers in Other Markets February 28, 2023 News Release A new analysis of health insurers’ 2021 financial data shows that insurers continue to report much higher gross margins per enrollee in the Medicare Advantage market than in other health insurance markets. The analysis examines insurers’ financial data in the Medicare Advantage, Medicaid managed care, individual (non-group), and fully insured…
Health Insurer Financial Performance in 2021 February 28, 2023 Issue Brief Using health insurer financial data for 2021, we find that Medicare Advantage insurers reported gross margins that were at least twice as high as those reported by insurers in the individual/non-group, fully-insured group/employer, and Medicaid managed care markets. The four markets report similar simple medical-loss-ratios.
Outpatient Visits Are Growing More Complex: Implications for Health Costs February 27, 2023 Issue Brief This analysis for the Peterson-KFF Health System Tracker uses claims data from private, large employer-based plan to examine trends in complexity coding across outpatient practice settings from 2004 to 2021. It finds a trend toward higher complexity codes that contributes to higher outpatient spending.
Claims Denials and Appeals in ACA Marketplace Plans in 2021 February 9, 2023 Issue Brief This analysis of HealthCare.gov Marketplace insurers’ transparency data finds that 17% of in-network claims were denied in 2021, with denial rates varying widely across insurers. Consumers appealed less than two-tenths of 1% of denied in-network claims.
The End of the COVID-19 Public Health Emergency: Details on Health Coverage and Access February 3, 2023 Blog This post provides an overview of how health care coverage and access will and won’t change when the public health emergency ends on May 11, including a discussion of COVID-19 vaccines, tests, and treatments, and telemedicine.
About 5 Million Uninsured People Could Get ACA Marketplace Coverage Without a Monthly Premium – But They Would Have to Enroll Soon January 10, 2023 News Release About 5 million uninsured people across the country could get coverage through an Affordable Care Act Marketplace health plan with virtually no monthly premium if they enroll soon, a new KFF analysis finds. In most states, open enrollment runs through January 15, with tax credits available to help eligible low-…
Millions of Uninsured People Can Get Free ACA Plans January 10, 2023 Blog This post estimates that about 5 million uninsured people across the country could get coverage through an Affordable Care Act (ACA) Marketplace health plan with virtually no monthly premium if they enroll during the 2023 open enrollment period, which runs through Jan. 15 in most states.
How ACA Marketplace Premiums Are Changing by County in 2023 December 19, 2022 Issue Brief This analysis details how ACA marketplace premiums are changing from 2022 to 2023, and the impact of subsidies to make them more affordable. Premiums vary based on location and metal level, and t T analysis details how premiums are changing from 2022 to 2023, including where no-premium plans are available for people of varying income levels.
Emergency Department Visits Exceed Affordability Threshold For Many Consumers With Private Insurance December 16, 2022 Issue Brief This analysis uses 2019 insurance claims data from large employer health plans to assess the total and out-of-pocket costs of emergency department visits, overall and by diagnosis and severity level. It also looks at which services contribute most to the costs of emergency department visits.
Navigating the Family Glitch Fix: Hurdles for Consumers with Employer-sponsored Coverage November 21, 2022 Issue Brief About 5 million people could benefit from the fix to the Affordable Care Act’s “family glitch” that allows workers offered unaffordable family coverage to get subsidies in the marketplace – if they can show they qualify. This brief looks at some of the challenges consumers may face in deciding whether to take advantage of the fix.