Individual Market

Most Insurers Participating in the Marketplaces Don’t Expect COVID to Affect Their 2022 Costs

After a tumultuous year of unpredictable COVID-19 changes to utilization and spending, a review of early rate filings for individual market insurers participating in the Affordable Care Act Marketplace finds that most are expecting a return to normal in 2022 without the pandemic playing a large role. The review of insurers’ preliminary rate filings in…More

Insurer Filings Suggest COVID-19 Pandemic Will Not Drive Health Spending In 2022

This brief reviews initial 2022 premium rate filings for Marketplace-participating individual market insurers in 13 states and the District of Columbia. Most expect health utilization patterns to return to pre-pandemic levels and therefore not factoring in any impact on their 2022 premiums.

Health Insurer Financial Performance in 2020

This analysis examines insurers’ financial data across markets through the end of 2020. It finds that average margins remained relatively high compared to recent years, suggesting many insurers remained profitable even as health spending rebounded and COVID-19 cases surged in the fall and winter.

Analysis Estimates 5.1 Million People Fall into the Affordable Care Act’s “Family Glitch”

A new KFF analysis estimates 5.1 million people nationally fall into the Affordable Care Act’s “family glitch” that occurs when a worker receives an offer of affordable employer coverage for themselves but not for their dependents, making them ineligible for financial assistance for marketplace coverage. The so-called glitch occurs because the ACA prohibits people with…More

The ACA Family Glitch and Affordability of Employer Coverage

This analysis estimates that 5.1 million people fall into the Affordable Care Act’s “family glitch,” which occurs when a worker receives an offer of affordable employer coverage for themselves but not for their dependents, making them ineligible for financial assistance for marketplace coverage. It explores the demographic characteristics of this group, including state-level estimates.

Web Briefing: Understanding the Health Coverage and Affordability Provisions in the American Rescue Plan Act

The American Rescue Plan (ARP) Act signed into law earlier this month includes a number of provisions aimed at making health coverage more accessible and affordable amid the public health and economic crises created by the COVID-19 pandemic. Join KFF at a web briefing to explain these changes and their expected impact on consumers, insurance …

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How the American Rescue Plan Act Affects Subsidies for Marketplace Shoppers and People Who Are Uninsured

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.

Impact of Key Provisions of the American Rescue Plan Act of 2021 COVID-19 Relief on Marketplace Premiums

This data note estimates how tax credits premiums will change for people at various ages and incomes under the temporary boost in subsidies included in the American Rescue Plan Act of 2021, the COVID-19 relief plan signed into law in March 2021.

Updated KFF Calculator Estimates Marketplace Premiums to Reflect Expanded Tax Credits in COVID-19 Relief Legislation

KFF has updated its 2021 Health Insurance Marketplace Calculator to reflect the expanded premium tax credits available to people who purchase their own coverage through their state’s health insurance exchange as passed by Congress in the American Rescue Plan Act and expected to be signed into law soon. The calculator allows users to enter their…More

Two New Analyses: House COVID-19 Relief Plan Would Temporarily Lower Marketplace Premiums for Millions and More than Offset Short-Term State Costs to Expand Their Medicaid Programs

The House COVID-19 relief proposal would temporarily lower what millions of Marketplace enrollees and uninsured potential enrollees would pay toward premiums and would provide states that have not expanded their Medicaid programs a financial boost that would more than offset their costs initially, two new KFF analyses find. The analyses assess two parts of the…More

Nearly 9 Million Uninsured Americans Could Get Free or Subsidized Health Insurance if the Biden Administration Re-Opens ACA Marketplace Enrollment in Response to COVID-19

Four million uninsured people could get an ACA bronze plan with no premium payment and 4.9 million others could get subsidies to offset the cost of such a plan if the Biden Administration were to re-open ACA marketplace enrollment, a KFF analysis finds. Four million uninsured people could get an ACA bronze plan with no…More

Claims Denials and Appeals in ACA Marketplace Plans

Based on an analysis of transparency data released by the Centers for Medicare and Medicaid Services (CMS), this brief assess claims denials and appeals among issuers offering individual market coverage on healthcare.gov and finds that 17% of in-network claims were denied by issuers in 2019, with denial rates for specific issuers varying significantly around this …

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Get Ready for a Lot of Biden Executive Orders on Health Care

In this column for the JAMA Health Forum, Larry Levitt explores what President-elect Biden might do to advance his health care vision both through legislation and through executive orders and waivers and demonstrations.

Health Insurer Financial Performance Through September 2020

In this brief, we analyze third quarter data from 2018 to 2020 to examine how insurance markets performed financially through the end of September. Average margins remained relatively high compared to the same point in recent years, suggesting many insurers remained profitable even as non-COVID-related care returned in the summer and fall.

Millions of Uninsured Americans are Eligible for Free ACA Health Insurance

Amid the ongoing pandemic and high unemployment, this poste xamines how many uninsured people would be eligible for free health insurance during in a typical year, including those who qualify for Medicaid or for tax credits that cover the full cost of an ACA Marketplace plan.

Tracking Section 1332 State Innovation Waivers

This interactive map shows the status of all Section 1332 waivers requested by states. The Affordable Care Act (ACA) allows states to apply for innovation waivers to alter key ACA requirements in the individual and small group insurance markets and can be used to shore up fragile insurance markets, address unique state insurance market issues, …

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Explaining Health Care Reform: Questions About Health Insurance Subsidies

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 …

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2021 Premium Changes on ACA Exchanges and the Impact of COVID-19 on Rates

A look at preliminary marketplace rate filings reveals many premium changes for 2021 are moderate thus far, with increases or decreases of a few percentage points. However, most insurers have not yet incorporated the rate impacts of the COVID-19 pandemic in their rate changes for 2021, so many of these proposed rates are likely to …

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An Early Look at 2021 Premium Changes on ACA Exchanges and the Impact of COVID-19 on Rates

A look at preliminary marketplace rate filings reveals many premium changes for 2021 are moderate thus far, with increases or decreases of a few percentage points. However, most insurers have not yet incorporated the rate impacts of the COVID-19 pandemic in their rate changes for 2021, so many of these proposed rates are likely to …

An Early Look at 2021 Premium Changes on ACA Exchanges and the Impact of COVID-19 on Rates Read More »

Individual Insurance Market Performance in Early 2020

Individual market insurers, on average, remained profitable through the first three months of 2020 as claims costs rose only slightly compared to the same period last year. It is likely that the most significant impacts of the coronavirus on the individual market will not be evident nationally until second or third quarter data are released.