Healthcare.gov marketplace insurers denied 18% of all claims — nearly 1 out of every five — submitted for in-network services in 2020. But the reasons behind the high denial rates and the ultimate consequences for consumers are difficult to determine, according to a new analysis by the Kaiser Family Foundation (KFF).
The Affordable Care Act (ACA) requires insurers to report data about claims denials and appeals to encourage transparency about how insurance coverage works for enrollees. KFF's analysis examined data released by the Centers for Medicare and Medicaid Services on more than 230 million claims submitted to 144 insurers selling marketplace coverage in 2020, the most recent year for which data is available.
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