Patient and Consumer Protections
Examining Short-Term Limited-Duration Health Plans
As Marketplace Open Enrollment nears, policy changes could leave millions of people facing substantially higher premiums and coverage loss, which could lead more consumers to purchase less expensive and less comprehensive coverage through short-term health plans. KFF analyzes short-term health policies sold by nine large insurers in 36 states, examining premiums, cost sharing, covered benefits, and coverage limitations and comparing them to ACA Marketplace plans.
Prior AUthorization
The Public’s Views and Experiences with Prior Authorization
Following a pledge by insurance companies to reduce the burden of prior authorizations, KFF’s Health Tracking Poll examines the publics experience with the process. The poll finds that most view insurers’ delays and denials as a problem, and few are aware of the newly announced pledge.
Medicare Advantage Insurers And Prior Authorization Determinations
Nearly 50 million prior authorization requests were submitted to Medicare Advantage insurers on behalf of Medicare Advantage enrollees in 2023, of which 3.2 million (6.4%) were denied. Just 11.7% of denied requests were appealed, though 81.7% of appeals overturned the initial denial in Medicare Advantage.
Prior Authorization Process Policies in Medicaid Managed Care
This brief examines state policies related to prior authorization processes in Medicaid managed care and includes findings about how states approach prior authorization decision timeframes, electronic denial notices, and access to external medical reviews, all as of July 1, 2024.
Other Issues
Proposed Mental Health Parity Rule Signals New Focus on Outcome Data as Tool to Assess Compliance
Proposed updates to federal mental health parity rules would make wide ranging changes to current standards that apply to private insurance and coverage provided by most employers. This issue brief focuses on a requirement that plans perform an “outcome analysis."
Health Care Debt In The U.S.: The Broad Consequences Of Medical And Dental Bills
The KFF Health Care Debt Survey finds that four in ten adults have some form of health care debt, with most citing one-time or short-term medical expenses as the contributor. Many of those with health care debt report making personal sacrifices and enduring financial consequences as a result of their debt, while nearly one in five think they will never be able to pay off.
SCOTUS DECISION on “Chevron Deference” Could Have Big Impacts on Health Policy
The Supreme Court decision overturning “Chevron deference” has profound implications for health care.
It ushers in an era in which courts will not have to accept agency expertise in their review of challenged federal regulations.
Claims Denials and Appeals in ACA Marketplace Plans in 2023
This brief analyzes federal transparency data released by the Centers for Medicare and Medicaid Services (CMS) on claims denials and appeals for non-group qualified health plans (QHPs) offered on HealthCare.gov in 2023. It finds that HealthCare.gov insurers denied nearly one out of every five claims (19%) submitted for in-network services.
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8 Things to Watch for the 2026 ACA Open Enrollment Period
Issue BriefThe ACA Marketplace Open Enrollment season begins November 1, and with it comes looming changes to the enhanced premium tax credits, increases in out-of-pocket premium payments, new Marketplace eligibility rules, and more. Read our analysis of what these and other changes could mean for new and returning enrollees.
Examining Short-Term Limited-Duration Health Plans on the Eve of ACA Marketplace Open Enrollment
Issue BriefAs Marketplace Open Enrollment nears, policy changes could leave millions of people facing substantially higher premiums and coverage loss, which could lead more consumers to purchase less expensive and less comprehensive coverage through short-term health plans. KFF analyzes short-term health policies sold by nine large insurers in 36 states, examining premiums, cost sharing, covered benefits, and coverage limitations and comparing them to ACA Marketplace plans.
The Regulation of Private Health Insurance
FeatureThis Health Policy 101 chapter explores the complex landscape of private health insurance regulation in the United States, detailing the interplay between state and federal regulations that shape access, affordability, and the adequacy of private health coverage. It focuses on key laws such as the Affordable Care Act (ACA) and the Employer Retirement Income Security Act (ERISA), and discusses how regulations impact the private insurance market, illustrating the challenges consumers face in navigating this system.
Charting the Way Forward: New Efforts to Advance Electronic Health Information Sharing
Issue BriefIn July 2025, the Trump administration announced a new effort (“Making Health Tech Great Again”) towards health data interchange.. This brief describes the new, voluntary Trump administration interoperability initiative, provides an overview of key health information technology laws and regulations, and highlights some of the challenges and limitations of these efforts.
Access to OB-GYNs: Evaluating Workforce Supply and ACA Marketplace Networks
Issue BriefThis brief examines the supply of OB-GYNs in the U.S. and the share of OB-GYNs participating in the provider networks of Qualified Health Plans (QHPs) offered in the individual market in the federal and state Affordable Care Act (ACA) Marketplaces in 2021.
Fraud in Marketplace Enrollment and Eligibility: Five Things to Know
Issue BriefThis brief evaluates what is currently known about fraud and abuse in the Affordable Care Act (ACA) Marketplace, including how the final Marketplace Integrity and Affordability Rule and the recently enacted budget reconciliation law change existing Marketplace enrollment and eligibility standards.
Navigating the Maze: A Look at Patient Cost-Sharing Complexities and Consumer Protections
Issue BriefThis brief focuses on consumers’ understanding of health insurance costs and examines existing federal protections that seek to address barriers to understanding the cost of coverage and care, such as price transparency, self-service price estimator tools, and simplifying cost-sharing designs.
Navigating the Maze: A Look at Health Insurance Complexities and Consumer Protections
Issue BriefThis brief discusses how consumers understand what their insurance covers, what to do when coverage for care is denied, and what protections exist to ensure that information is available and coverage determinations are fair, accurate, and timely.
HealthCare.gov Insurers Denied Nearly 1 in 5 In-Network Claims in 2023, but Information About Reasons is Limited in Public Data
News ReleaseHealthCare.gov insurers denied nearly one out of every five claims (19%) submitted for in-network services and an even larger share (37%) share of claims for out-of-network services in 2023, a new KFF analysis finds.
How Does the Department of Health and Human Services (HHS) Impact Health and Health Care?
Policy WatchThis policy watch provides a short overview of the Department of Health and Human Services (HHS), describing its history, budget, organizational structure and its major programs and responsibilities.