HealthCare.gov Plans Deny 19% of Claims, but Reasons Are Murky
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Jan 31, 2025
Around 19% of claims from federally facilitated exchange plans were denied in 2023, according to data from a recent KFF report. Experts say the report illustrates a greater need for more data reporting and transparency from Affordable Care Act exchange plans, especially at the state level.
The publicly available data in the report only applies to qualified health plans sold on HealthCare.gov, which are required to report certain transparency data, including claim denial rates. The report does not include state-run exchanges, Medicare or employer-sponsored plans — meaning it covers a “very small sliver” of the health insurance market, says Michelle Long, report co-author and senior policy manager for KFF’s Program on Patient and Consumer Protections.
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