The lawsuit alleges that an Aetna policy discriminates against LGBTQ people by requiring them to pay thousands in out-of-pocket costs for fertility treatments before becoming eligible for coverage. Though Aetna has agreed to pay the costs incurred by the plaintiffs, the suit aims to strike down the policy as a whole.
After pushing back the start date twice, CMS now wants to scrap the Trump-era rule, which provides an expedited pathway to Medicare coverage for devices that receive the FDA breakthrough designation.
The increase in access to public health insurance coverage — via legislation like the Families First Coronavirus Response Act that prevents states from disenrolling Medicaid beneficiaries — helped offset the loss of employer-sponsored insurance, the report from Robert Wood Johnson Foundation shows.
This interactive map shows the increase in states with laws restricting abortion coverage in Medicaid and private insurance since 2010.
UnitedHealthcare and United Behavioral Health agreed to the settlement to resolve allegations that they illegally denied coverage for mental health and substance use disorder treatments. The allegations are related to business practices they no longer use, parent company UnitedHealth Group said.
As policy makers debate whether and how to extend coverage to people in the gap, understanding the characteristics of who these people are can help inform policy decisions.
This fact sheet provides an overview of health coverage for noncitizens and discusses key issues for health coverage and care for immigrant families today.
CMS plans to review and determine coverage for Biogen’s Aduhelm, the first new Alzheimer’s disease treatment in decades. But the jury is still out on the drug’s effectiveness. Not to mention, its hefty price tag — $56,000 — could drive up Medicare spending.
Per a policy update that went in to effect July 1, the health insurance giant is not covering non-emergency services that members receive at out-of-network facilities that are outside of their service area. This update mainly affects residential treatment facilities, inpatient rehabilitation and other non-hospital-based services.
Enrollment in Medicaid and the Children’s Health Insurance Program has reached a record high, with 80 million now covered through these programs. The spike was largely driven by the economic downturn brought on by the pandemic and a federal requirement that prevents states from removing people from the programs until the public health crisis is …
The Supreme Court upheld the Affordable Care Act, dismissing the lawsuit brought by Texas, 17 other states and two individuals on the grounds that they were not able to prove they were harmed by the law. Industry stakeholders celebrated the court’s long-awaited decision.
This issue brief highlights key differences between Medicare and Medicaid and raises questions about how a policy to lower the age of Medicare eligibility could affect individuals who are currently enrolled in Medicaid.
UnitedHealthcare is instituting a new policy beginning July 1 that changes how the payer assesses emergency department claims, allowing it to retroactively deny ones it deems “non-emergent” or not an emergency. The American College of Emergency Physicians has made its opposition clear, stating the policy may violate federal law.
This issue brief describes key characteristics of SSI enrollees, explains the SSI eligibility criteria and eligibility determination process, and considers the implications of changes in the SSI program for Medicaid, including the effects of the COVID-19 pandemic and resulting economic downturn as well as proposals supported by President Biden that Congress might consider.
Health insurers are prohibited from placing unfavorable limits on mental health and substance abuse benefits, and yet, many do. Federal and state regulators are taking aim at these practices and making the enforcement of the Mental Health Parity and Addiction Equity Act of 2008 a key focus.
A majority of the general public is in support of expanding Medicare — either by opening it up to all Americans or lowering the eligibility age, according to new survey results. But among current Medicare enrollees, nearly half want the program to stay as it is.
In this column for the JAMA Health Forum, Larry Levitt examines the implications of lowering Medicare’s age of eligibility, which is emerging as a potential pathway toward Medicare-for-all or a public option among single-payer advocates. He explores the implications for costs, industry, people and broader reform efforts.
A new KFF analysis shows that lowering the age of Medicare eligibility to 60 could improve the affordability of coverage for people who are already insured and expand coverage to over a million of the nation’s 30 million uninsured. Such a policy could provide a path to Medicare coverage for up to 11.7 million people…More
CMS delayed the start date of its rule that would provide expedited Medicare coverage for products the FDA deems “breakthrough devices” from May 15 to Dec. 15. CMS wants more time to examine concerns expressed about the rule, including that devices may gain coverage despite limited evidence of their use among seniors.
Providing paid time off to employees to get and recover from any side effects could help boost vaccination rates. Overall, nearly three in ten (28%) employed adults who not yet ready to get the vaccine say that they would be more likely to get the COVID-19 vaccine if their employer gave them paid time off …
Disparities in health and health care for people of color and underserved groups are longstanding challenges. The COVID-19 pandemic has exacerbated these disparities and heightened the importance of addressing them. Health disparities are driven by underlying social and economic inequities that are rooted in racism. Addressing disparities is important not only from a social justice …
New federal financial incentives for Medicaid expansion and the increased reliance on Medicaid as a coverage safety net during the pandemic have renewed debate in the 12 states that have not adopted the Medicaid expansion under the Affordable Care Act. A new KFF literature review provides context for these expansion debates by summarizing evidence from…More
This report summarizes evidence from nearly 200 studies on the effects of Medicaid expansion published between February 2020 and March 2021. These studies generally find beneficial impacts of expansion across a range of areas.
This page tracks recent state actions to extend Medicaid postpartum coverage, including approved and pending 1115 waivers, legislation that will require the state to seek federal approval through a SPA or 1115 waiver, submitted and approved SPAs, and coverage financed solely with state funds.
This survey of executive decision-makers at over 300 large private employers finds most see rising health costs as a threat to their businesses and believe a broader government role will be necessary to control health costs and ensure coverage.
Top executives at nearly 90% of large employers surveyed believe the cost of providing health benefits to employees will become unsustainable in the next five-to-10 years, and 85% expect the government will be required to intervene to provide coverage and contain costs, according to a new survey released today from Purchaser Business Group on Health…More
A new KFF issue brief explores several potential policy options that would help close the Affordable Care Act’s “coverage gap,” including providing further new incentives for states to expand Medicaid, creating a new “public option” or extending ACA Marketplace premium subsidies to low-income people who don’t currently qualify for federal help. At stake is affordable…More
This issue brief examines some of the other options policymakers may consider to extend coverage to people in the gap, including increased fiscal incentives for states, a narrower public option, and making people with incomes below the poverty level eligible for enhanced ACA premium subsidies.
This brief presents findings from the 2020 KFF Women’s Health Survey on women’s use of health care services, costs, and experiences accessing health care. The 2020 survey is a nationally representative survey of 3,661 women ages 18 to 64, conducted between November 19 and December 17, 2020.
As part of its ongoing effort to improve maternal outcomes in the country, the government has approved Illinois’ request to extend full Medicaid coverage for new mothers. The approval extends the coverage from 60 days to one year and will give about 2,500 women living below the poverty line access to care every year.
This brief use data from the American Community Survey (ACS) to provide estimates of eligibility for and the amount of financial assistance to purchase Marketplace coverage under the ARPA among both current individual market purchasers, as well as Marketplace-eligible uninsured people.
Using the most current data available, this analysis describes current sources of coverage among Medicare beneficiaries in 2018, including sources of supplemental coverage among traditional Medicare beneficiaries.
President Joe Biden recently signed the $1.9 trillion Covid-19 relief package into law. The American Rescue Plan Act includes several provisions to boost coverage under the ACA, like widening eligibility for premium tax credits.
This brief reviews information available through state websites and publicly available vaccine distribution plans to provide greater insight into how states are addressing equity through vaccine allocation and distribution strategies, outreach and communications efforts, and data collection and reporting. It provides a snapshot and examples of state efforts in these areas.
This issue brief explores the impact of COVID-19 on justice-involved populations, examines how states have prioritized these populations for vaccination, and highlights the significance of Medicaid coverage for this population as well as proposals to expand access to Medicaid coverage.
President Biden’s January 28th executive order to reopen enrollment in the federal ACA Marketplace from February 15 through May 15, combined with $50 million in federal spending on outreach and education about ACA coverage options, has the potential to reach millions of people who were uninsured prior to or have lost coverage during the pandemic. …
The two-page fact sheets provide a snapshot with key data for those who would become eligible for Medicaid under expansion in non-expansion states.
This data note discusses changes in the number of applications for Medicaid/CHIP coverage during the coronavirus pandemic. Although enrollment in Medicaid/CHIP has increased steadily by more than 6 million individuals (9%) from February to September 2020, the total number of Medicaid/CHIP applications has decreased by more than 150,000 (-6%) in the same time period. The …
Aetna will now cover breast augmentation for trans women, signaling hope for increased access to healthcare for the transgender community. The coverage expansion comes after transgender individuals and groups advocated for the change.
As a result of the COVID-19 Public Health Emergency (PHE) , states have experienced increased enrollment along with administrative challenges. After the PHE ends, states are likely to have renewal and redetermination backlogs and will face decisions around continuing temporary policy changes. This brief highlights key issues from the new CMS guidance to states on …
In states that do not implement the Medicaid expansion under the Affordable Care Act (ACA), many adults will fall into a “coverage gap” of earning too much to qualify for Medicaid but not enough to qualify for Marketplace premium tax credits. Nationwide, 2.2 million poor uninsured adults are in this situation. This brief presents estimates …
This analysis provides an overview of demographic characteristics and health insurance coverage of health care workers with direct patient contact, including those working in hospital and long-term care settings.
Published in the Jan. 19 edition of JAMA, this article from KFF Executive Vice President for Health Policy Larry Levitt lays out the major health policy challenges that will confront President-elect Biden and potential approaches to major reform. While a big reform debate may not be likely this year, one is likely coming as the…More
As the Biden Administration takes office, the ongoing effects of the coronavirus pandemic and related economic downturn are the key issues that will substantially shape Medicaid coverage and financing policy in the year ahead.
The agency has finalized a rule that allows it to provide immediate Medicare coverage for FDA-approved products that are deemed “breakthrough devices.” The new coverage process would enable seniors to get access to these devices more quickly, but some provider and payer groups are concerned that this could cause patient harm.
This factsheet reviews major sources of coverage for women residing in the U.S. in 2019, discusses the impact of the ACA on women’s coverage, and the coverage challenges that many women continue to face
The recent election of former Vice President Joe Biden as well as the on-going effects of the coronavirus pandemic and related economic downturn are the key issues that will substantially shape Medicaid policy over the next year.
Findings from administrative data suggest that the decline in enrollment among employer-sponsored insurance was far less than overall declines in employment as of September, and that many who did lose their job-based coverage likely found a safety net in coverage through Medicaid or the ACA marketplaces.
These FAQs provide the latest guidance on testing and treatment related to COVID-19 for Medicare beneficiaries.
Millions of Americans without healthcare insurance could be eligible to get coverage for free, or nearly free, through financial assistance offered under the Affordable Care Act. But many who recently lost their employer-based coverage may not be aware of the options available to them.
This data note examines employer-sponsored coverage for same-sex spouses during the first half of 2020, as well as trends over time, and the impact that three Supreme Court cases could have on this coverage.
The Affordable Care Act (ACA) requires new private health insurance plans to cover many recommended preventive services without any patient cost-sharing. This tracker presents up-to-date information on the adult preventive services nongrandfathered private plans must cover, by condition, including a summary of the recommendation, the target population, the effective date of coverage, and related federal …
The health insurer and Michigan-based physician organization are partnering to expand access to in-network care for around 40,000 individual and group Medicare Advantage plan members. The partnership will go into effect Dec. 1.
New analysis shows that, in 2019, the number of uninsured continued to increase for the third year in a row. Much of the coverage loss between 2018 and 2019 was among Hispanic people, and these data point to significant increased barriers to health care for Hispanic people.
This issue brief describes trends in health coverage prior to the pandemic, examines the characteristics of the uninsured population in 2019, and summarizes the access and financial implications of not having coverage.
In a review of real-world claims data, Pear Therapeutics found that its digital therapeutic for opioid use disorder resulted in a reduction in spending $2,150 per patient over six months.
This data note presents the latest state-level data about nonelderly Medicaid adults who have disabilities but do not quality for SSI and considers the implications for their continued coverage if the ACA expansion is invalidated by the Court.
This brief describes health insurance subsidies available through the Affordable Care Act’s marketplaces, including premium subsidies that would be provided in the form of tax credits, as well as other subsidies that would lower cost sharing to eligible Americans. It provides details on who is eligible for the assistance, the maximum repayment limits for the …
CMS’ interim rule states that Medicare will cover Covid-19 vaccines approved by the FDA, including those receiving emergency use authorization, in a reversal from its usual policy. The vaccine will be made available at no cost to Medicare beneficiaries.
In recent weeks, the possible overturning of the Affordable Care Act (ACA) in court and the upcoming election have focused attention on the issue of protections for people with pre-existing conditions. While the focus has been on the ACA’s private insurance protections, Medicaid also plays a significant role in covering people with pre-existing conditions.
Health care is a top issue for voters in the 2020 election. To understand the health care landscape in which the 2020 election policy debates will unfold, these state health care snapshots provide data across a variety of health policy subjects, including health care costs, health coverage—Medicaid, Medicare, private insurance—and the uninsured, women’s health, health …
U.S. Supreme Court decisions shape health policy in important ways. The nomination of Judge Amy Coney Barrett, if confirmed, is expected to establish a solid 6:3 conservative majority that could affect case outcomes in several areas. This issue brief considers the potential implications of a reconfigured Court for health policy issues, including those already on …
San Francisco – Annual family premiums for employer-sponsored health insurance rose 4% to average $21,342 this year, according to the 2020 benchmark KFF Employer Health Benefits Survey. On average, workers this year are contributing $5,588 toward the cost of family coverage, with employers paying the rest. The survey was conducted from January to July as…More
This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs, and employer practices. Annual premiums for employer-sponsored family health coverage reached $21,342 this year, up 4% from last year, with workers on average paying $5,588 toward the cost of their …
Health insurance coverage and access to care improve health outcomes, including viral suppression, for people with HIV in the United States. Prior research has demonstrated that implementation of the Affordable Care Act (ACA) in 2014 increased coverage among people with HIV and that certain forms of coverage are positively correlated with sustained viral suppression. We …
This page displays an interactive map of the current status of state decisions on the Affordable Care Act’s Medicaid expansion. Additional Medicaid expansion resources are listed (with links) below the map.