Premiums

Understanding the Impact of Medicaid Premiums & Cost-Sharing: Updated Evidence from the Literature and Section 1115 Waivers

Our review of recent literature on premiums and cost-sharing is based on studies and reports published between 2017 and 2021. Our analysis of premiums in post-Affordable Care Act (ACA) Section 1115 waivers (approved under the Obama and Trump administrations) is based on available interim and final waiver evaluations as well as annual and quarterly state …

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How Would Drug Price Negotiation Affect Medicare Part D Premiums?

Proposals to allow the federal government to negotiate prescription drug prices, such as H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act, aim to lower out-of-pocket drug costs for Medicare beneficiaries and private plan enrollees and achieve savings for Medicare. This data note estimates average premium savings attributable to the negotiations provision of …

How Would Drug Price Negotiation Affect Medicare Part D Premiums? Read More »

What insurers’ premium rate filings can tell us about predicted health utilization in 2022

An examination of health insurers’ premium rate filings for 2022 shows that most are not factoring in additional costs or savings, which indicates that they expect health utilization to reach pre-pandemic levels.

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.

Key Facts About Medicare Part D Enrollment, Premiums, and Cost Sharing in 2021

The Medicare Part D program provides an outpatient prescription drug benefit to older adults and people with long-term disabilities in Medicare who enroll in private plans, including stand-alone drug plans and Medicare Advantage drug plans. This analysis provides the latest data about Part D enrollment, premiums, and cost sharing in 2021 and trends over time.

Suficiente para arruinar el descanso: le cobran $10,322 por un estudio del sueño

Los ronquidos de José Mendoza eran malos, pero para su esposa Nancy era peor cuando dejaba de respirar. El repentino silencio la despertaba, y si pasaban demasiados segundos, lo zarandeaba para que comenzara a respirar de nuevo. Esto sucedía varias veces a la semana. Diagnosticado con apnea del sueño severa hace 15 años, a Mendoza …

Suficiente para arruinar el descanso: le cobran $10,322 por un estudio del sueño Read More »

Enough to Wreck Their Rest: $10,322 for a Sleep Study

José Mendoza’s snoring was bad — but the silence when he stopped breathing was even worse for his wife, Nancy. The sudden quiet would wake her and she waited anxiously for him to take another breath. If too many seconds ticked by, she pushed him hard so that he moved and started breathing again. This …

Enough to Wreck Their Rest: $10,322 for a Sleep Study Read More »

Survey: Large employers want more government action to curb healthcare costs

Executives at large companies feel that the cost of providing employee health benefits will become unsustainable within the next decade, a new survey shows. They want the government to play a bigger role in providing coverage and lowering costs.

What a Difference a Year Makes in Colorado’s Case for a Public Option Plan

DENVER — Before the pandemic, Colorado looked set to become the second state to pass what’s known as a “public option” health insurance plan, which would have forced hospitals that lawmakers said were raking in obscene profits to accept lower payments. But when covid-19 struck, legislators hit pause. Use Our Content It can be republished …

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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.

The Great Undoing: Which of Trump’s Policies Will Biden Reverse?

KHN has put together an interactive tool of significant health policies implemented by the Trump administration using its own authority — executive orders, agency guidance or formal regulations — and is tracking Biden administration and court actions. We will update this chart as actions are taken. Topics: Affordable Care Act | HHS Operations | Immigration …

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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.

Lots of Health Insurance Help in Covid Relief Law — But Do Your Homework First

There’s something for everyone with private health insurance in the American Rescue Plan Act, but determining the best way to benefit may be confusing. This story also ran on NBC News. It can be republished for free. The $1.9 trillion covid relief law that President Joe Biden signed this month will make coverage significantly more …

Lots of Health Insurance Help in Covid Relief Law — But Do Your Homework First Read More »

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

2021 Calculator – Before COVID-19 Relief

The Health Insurance Marketplace Calculator, updated with 2021 premium data and to reflect subsidies in the American Rescue Plan Act of 2021, provides estimates of health insurance premiums and subsidies for people purchasing insurance on their own in health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA). With this calculator, you can …

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2021 Calculator – Before COVID-19 Relief

The Health Insurance Marketplace Calculator, updated with 2021 premium data and to reflect subsidies in the American Rescue Plan Act of 2021, provides estimates of health insurance premiums and subsidies for people purchasing insurance on their own in health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA). With this calculator, you can …

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Health Insurance Marketplace Calculator

The Health Insurance Marketplace Calculator, updated with 2021 premium data and to reflect subsidies in the American Rescue Plan Act of 2021, provides estimates of health insurance premiums and subsidies for people purchasing insurance on their own in health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA). With this calculator, you can …

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Pandemic Aid Package Includes Relief From High Premiums

This story also ran on NPR. It can be republished for free. As President Joe Biden’s pandemic relief package steams through Congress, Democrats have hitched a ride for a top health care priority: strengthening the Affordable Care Act with some of the most significant changes to insurance affordability in more than a decade. The bill …

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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

Health Policy Valentines to Warm the Heart

Nothing warms our hearts like a few good Health Policy Valentines ― especially those that are sweet on KHN. Tweeters lit up our timeline in recent days with valentine messages about topics ranging from covid-19 vaccines and mask-wearing to the price of health care. Here are some of our favorites. ❤ Roses are red Violets …

Health Policy Valentines to Warm the Heart Read More »

A Dozen Facts About Medicare Advantage in 2020

Medicare Advantage enrollment has grown rapidly over the past decade, and Medicare Advantage plans have taken on a larger role in the Medicare program. More than 24 million Medicare beneficiaries (36%) are enrolled in Medicare Advantage plans in 2020. This data analysis provides updated information about Medicare Advantage enrollment trends, premiums, and out-of-pocket limits. It …

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Options to Make Medicare More Affordable For Beneficiaries Amid the COVID-19 Pandemic and Beyond

Medicare provides significant health and financial protections to more than 60 million Americans, but there are gaps in coverage and high cost-sharing requirements that can make health care difficult to afford. This report analyzes several policy options that could help make health care more affordable for people covered by Medicare: adding an out-of-pocket limit to …

Options to Make Medicare More Affordable For Beneficiaries Amid the COVID-19 Pandemic and Beyond Read More »

During ACA Open Enrollment, Picking a Plan Invites New COVID Complications

People buying their own health insurance have even more to think about this year, particularly those post-COVID-19 patients with lingering health concerns, the “long haulers,” who join the club of Americans with preexisting conditions. What type of plan is best for someone with an unpredictable, ongoing medical concern? That question is popping up on online …

During ACA Open Enrollment, Picking a Plan Invites New COVID Complications Read More »

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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Medicare Advantage 2021 Spotlight: First Look

For 2021, the average Medicare beneficiary has access to 33 Medicare Advantage plans, the largest number of options available in the last decade, and can choose from plans offered by eight firms. Among the majority of Medicare Advantage plans that cover prescription drugs, 54 percent will charge no premium in addition to the monthly Medicare …

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Medicare Part D: A First Look at Medicare Prescription Drug Plans in 2021

This issue brief provides an overview of the Medicare Part D prescription drug benefit plan landscape for 2021, with a focus on stand-alone drug plans. It includes national and state-level data on plan availability, premiums, benefit design, cost sharing, information about premium-free plans for low-income beneficiaries, and information about the national Part D drug plans …

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2020 Health Insurance Marketplace Calculator

The Health Insurance Marketplace Calculator, updated with 2020 premium data, provides estimates of health insurance premiums and subsidies for people purchasing insurance on their own in health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA). With this calculator, you can enter your income, age, and family size to estimate your eligibility for …

2020 Health Insurance Marketplace Calculator Read More »

App-Based Companies Pushing Prop. 22 Say Drivers Will Get Health Benefits. Will They?

App-based driving services such as Uber, Lyft, DoorDash and Instacart are bankrolling California’s Proposition 22, which would keep their drivers classified as independent contractors, not employees. Leading into the Nov. 3 election, the ballot measure — which has become the most expensive in state history — is mired in controversy and the subject of a …

App-Based Companies Pushing Prop. 22 Say Drivers Will Get Health Benefits. Will They? Read More »

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 …

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

Premiums and Worker Contributions Among Workers Covered by Employer-Sponsored Coverage, 1999-2020

This graphing tool allows users to explore trends in workplace-sponsored health insurance premiums and worker contributions over time for different categories of employers based on results from the annual Employer Health Benefits Survey. Breakouts are available by firm size, region and industry, as well as for firms with relatively few or many part-time workers, higher- …

Premiums and Worker Contributions Among Workers Covered by Employer-Sponsored Coverage, 1999-2020 Read More »

2020 Employer Health Benefits Survey

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 …

2020 Employer Health Benefits Survey Read More »

Job-Based Health Insurance Costs Are Up 4% This Year, 55% in Past Decade

Health insurance costs for Americans who get their coverage through work continued a relentless march upward with average family premiums rising 4% to $21,342 this year, according to a study published Thursday. The annual survey by KFF found workers on average are paying nearly $5,600 this year toward family coverage, up from about $4,000 in …

Job-Based Health Insurance Costs Are Up 4% This Year, 55% in Past Decade Read More »

Don’t Count on Lower Premiums Despite Pandemic-Driven Boon for Insurers

When COVID-19 smacked the United States in March and April, health plans feared medical costs could skyrocket, jacking up premiums drastically in 2021, when millions of the newly unemployed might still be out of work. But something else happened: Non-COVID care collapsed as hospitals emptied beds and shut down operating rooms to prepare for an …

Don’t Count on Lower Premiums Despite Pandemic-Driven Boon for Insurers Read More »

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 »