Private Insurance

This analysis assesses whether people can afford to pay cost-sharing amounts common with private insurance plans. It finds that large shares of non-elderly households do not have enough liquid assets to meet typical plan cost-sharing amounts.

Continuous enrollment in Medicaid and enhanced premium assistance have helped millions afford and maintain coverage, but those gains could be reversed as the public emergency ends and if the provisions like those in the Build Back Better Act fail to pass.

Telehealth use skyrocketed during the early months of the pandemic. While it has since decreased somewhat from that high, it still represents a much more substantial share of health care than before COVID, this KFF-Epic Research analysis finds.

Health plan networks affect patient access to care. This brief reviews options for setting and enforcing network adequacy standards and tools for making differences in plan networks more transparent.

Forty-seven states saw Marketplace enrollment increase, ranging from 1% in Rhode Island to 42% in Texas. In 20 states, enrollment increased by more than 20%.

Less than a week after a new federal mandate to cover such products took effect, about half of the nation’s largest private insurers allow enrollees to directly obtain rapid at-home COVID-19 tests from specific sources without having to pay anything upfront, a new KFF analysis finds. The new coverage requirement…

This policy watch provides an early look at how top private insurers are implementing a new requirement to cover the cost of at-home COVID-19 tests. Initially about half offer a direct coverage option and half require an enrollee to pay upfront and then seek reimbursement.

In this column for the JAMA Health Forum, Larry Levitt examines how the No Surprises Act that prohibits unexpected out-of-network charges for patients could lead to lower payment rates and revenues for some doctors and other care providers.

In this commentary for Barron’s, Cynthia Cox and Lindsey Dawson examine the cost and availability of at-home COVID-19 tests and how the new Biden administration policy requiring private insurances to cover their costs may work. 

The Affordable Care Act (ACA) gives consumers the right to appeal private health plan claims denials and other adverse decisions, including the incorrect application of cost sharing, although limits apply. This issue brief describes consumer access to appeals and limits on appeal rights that have been adopted through federal regulations.