Cost Sharing

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.

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…

The debate about the future of the Affordable Care Act and its individual insurance marketplaces may be taking the focus off the affordability challenges facing the broader population, most of whom get their health coverage through employers, Medicare or Medicaid. New survey findings from the Kaiser Family Foundation show that…

On the seventh anniversary of the passing of the Affordable Care Act, this Data Note highlights five of the most common misconceptions surrounding the 2010 health care law.

This note illustrates the impact of the cost-sharing reductions in current law by looking at how they affect average deductibles and out-of-pocket maximum limits in benchmark silver plans in 2017 in states using the federally facilitated marketplace.

Premiums, insurer choice, and overall stability of 2018 Affordable Care Act (ACA) marketplaces could be affected by decisions from Congress and the Trump Administration on the health law’s cost-sharing reduction provision. With a legal appeal pending on a lawsuit from the U.S. House, the federal government and Congress are in…

A new Kaiser Family Foundation analysis finds that the average premium for a benchmark silver plan in Affordable Care Act (ACA) marketplaces would need to increase by an estimated 19 percent for insurers to compensate for lost funding if they don’t receive federal payment for ACA cost-sharing subsidies. Established by…

In this April 2017 post, Larry Levitt discusses the current status of the Affordable Care Act’s health insurance marketplaces, and explains how the Trump administration’s choices — including whether to continue cost-sharing reduction payments to insurers — could influence stability of the marketplaces going forward. The post is now available at The JAMA Forum.

This analysis estimates that total federal spending on Affordable Care Act marketplace subsidies would rise $2.3 billion, or 23 percent, in 2018 if payments for the cost-sharing reduction program were eliminated and insurers increased premiums to compensate. Established to reduce out-of-pocket costs for marketplace enrollees with lower incomes, the cost-sharing payments are being challenged in a lawsuit from the U.S. House.

Ceasing payments for the Affordable Care Act’s (ACA) cost-sharing reduction program could save $10 billion, but cost an additional $12.3 billion in premium tax credits – an estimated net increase of $2.3 billion, or 23 percent, in federal spending on marketplace subsidies – in 2018, if insurers continue to participate…