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. Substantially fewer prior authorization requests were made in traditional Medicare,…
This fact sheet reviews current national and state policies around Emergency Contraception, including methods, patient awareness, access and availability, and insurance coverage. Among methods discussed are ulipristal acetate (ella), intrauterine devices (copper IUDs and levonorgestrel IUDs), and progestin-based pills (Plan B and Next Choice).
This guide provides an overview of executive orders and other executive actions made by the Trump Administration since January 21, 2025 that directly address or affect U.S. global health efforts. This resource identifies each executive action, describes its purpose and actions taken, and outlines the implications and what happens next for each. The resource will…
As margins tighten, traditional revenue cycle management strategies are on shaky ground. Many healthcare providers are turning to automation and AI to simplify payments, prevent revenue loss and protect profits. This article breaks down some of the most common revenue cycle management (RCM) challenges facing healthcare leaders and offers a practical checklist to optimize patient…
As Senate hearings begin for President Trump’s health nominees, including Robert F. Kennedy Jr., the latest KFF Tracking Poll on Health Information and Trust shows a decline in public trust for government health agencies like the CDC, FDA, and local public health officials. The poll reveals growing skepticism about vaccines and school vaccine requirements, especially…
As President Trump begins his second term, the public’s trust in health information from key health agencies has fallen over the past 18 months, continuing a decline that began during the COVID-19 pandemic, finds the new KFF Tracking Poll on Health Information and Trust. Just over half (53%) of the public now says they trust…More
HealthCare.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. The analysis examines the main source of publicly available data on claims denials and appeals for individual-market plans available through the…More
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. Information about the reasons for…
Health coverage enrollment through the Affordable Care Act (ACA) marketplaces now exceeds 24 million people, a dramatic increase in recent years fueled largely by enhanced premium aid, which started in 2021 as part of the American Rescue Plan Act and extended through 2025 under the Inflation Reduction Act. But, with the subsidies set to expire…More
Section 1115 Medicaid demonstration waivers offer states an avenue to test new approaches in Medicaid that differ from what is required by federal statute. Nearly all states have at least one active Section 1115 waiver and some states have multiple 1115 waivers. This brief explains what Section 1115 waivers are and how they are used,…