Health insurance is a massive machine in the U.S., moving $1.2 trillion in benefits in 2023 while driving $1.6 trillion in premiums and $611 billion in net written premiums, and that is just the start of what makes this industry so dynamic.
Key Takeaways
- In 2023, U.S. health insurers provided $1.2 trillion in total benefits to members, according to the National Association of Insurance Commissioners (NAIC) data summarized by A.M. Best
- In 2023, the U.S. health insurance industry had $1.3 trillion in incurred claims, per NAIC data summarized by A.M. Best
- In 2023, U.S. health insurers had $1.6 trillion in premiums, per NAIC data summarized by A.M. Best
- In the ACA marketplaces in 2023, 8.6 million people selected plans during Open Enrollment
- In 2023, the ACA marketplace had 12.9 million total plan selections across categories (enrolled population)
- In 2023, 3.5 million people in ACA marketplaces received cost-sharing reductions (CSRs)
- In 2022, 18% of Americans under 65 reported having a deductible
- In 2022, average deductibles for single coverage in employer plans were $1,735
- In 2022, average deductibles for family coverage in employer plans were $3,590
- In 2022, medical loss ratio (MLR) rebates paid by health insurers were $1.8 billion under ACA MLR rules
- In 2021, MLR rebates paid were $1.0 billion
- In 2023, ACA-compliant individual market insurers had a minimum required MLR of 80%
- In 2023, total U.S. health insurer administrative costs were estimated at $1,076 per person
- In 2023, administrative costs for private insurance were estimated at 12.7% of premiums
- In 2023, administrative costs for Medicare were estimated at 2.4% of premiums
U.S. health insurers delivered trillions in benefits, covering millions amid rising costs.
Industry Size & Financials
1In 2023, U.S. health insurers provided $1.2 trillion in total benefits to members, according to the National Association of Insurance Commissioners (NAIC) data summarized by A.M. Best[1]
Verified2In 2023, the U.S. health insurance industry had $1.3 trillion in incurred claims, per NAIC data summarized by A.M. Best[1]
Verified3In 2023, U.S. health insurers had $1.6 trillion in premiums, per NAIC data summarized by A.M. Best[1]
Verified4In 2023, U.S. health insurers had $611 billion in net written premiums, per NAIC data summarized by S&P Global Market Intelligence (article page)[2]
Directional5In 2022, U.S. private health insurance premiums were $1.38 trillion[3]
Single source6In 2022, employer-sponsored insurance (ESI) spending was $6,575 per enrollee[4]
Verified7In 2022, average annual premium for employer-sponsored coverage was $7,739 for single coverage and $22,221 for family coverage[4]
Verified8In 2022, average employer contribution for single coverage was $6,106 and for family coverage was $17,771[4]
Verified9In 2022, average employee contribution for single coverage was $1,633 and for family coverage was $4,451[4]
Directional10In 2022, the share of nonelderly people with private health insurance was 86.6%[5]
Single source11In 2022, the number of people in the U.S. enrolled in employer-sponsored insurance was about 158.6 million[6]
Verified12In 2022, Medicaid covered 82.2 million people in the U.S. (all ages)[7]
Verified13In 2022, Medicare covered 65.5 million people in the U.S.[8]
Verified14In 2022, marketplace enrollment (ACA Exchanges) was 12.2 million people[9]
Directional15In 2022, the average monthly premium for a benchmark plan in the ACA marketplace was $412[10]
Single source16In 2022, the total number of people buying coverage through the ACA marketplace was 12.2 million[9]
Verified17In 2023, total U.S. Medicare Advantage enrollment was 28.0 million[11]
Verified18In 2023, Medicare Advantage accounted for 51% of Medicare beneficiaries[12]
Verified19In 2023, Medicaid/CHIP enrollment was 90.2 million people[13]
Directional20In 2022, private health insurance covered 266.1 million people in the U.S.[14]
Single source21In 2022, the share of U.S. residents with health insurance was 91.5%[5]
Verified22In 2022, the Uninsured rate in the U.S. was 8.5%[5]
Verified23In 2022, the average annual spending per person on health insurance premiums was $5,200 (employer and other sources combined)[15]
Verified24In 2021, total U.S. national health expenditures were $4.3 trillion[16]
Directional25In 2021, national health expenditures grew by 4.9%[16]
Single source26In 2021, spending on health care services by insurers represented a major portion of national health expenditures; national health expenditures table shows insurer-related spending[16]
Verified27In 2022, per capita spending on health care in the U.S. was $12,555[16]
Verified28In 2022, health insurance spending included in national health expenditures rose to $1.8 trillion[16]
Verified29In 2021, private health insurance spending in national health expenditures was $1.5 trillion[16]
Directional30In 2022, public health insurance spending was $1.8 trillion in national health expenditures[16]
Single source31In 2022, Medicare accounted for 20% of national health expenditures[16]
Verified32In 2022, Medicaid accounted for 17% of national health expenditures[16]
Verified33In 2022, private insurance accounted for 34% of national health expenditures[16]
Verified34In 2022, the share of health expenditures spent on administrative costs was estimated at 8% for private insurance[17]
Directional35In 2022, administrative costs for public coverage were estimated at 3% (Medicare/Medicaid administrative costs comparison)[17]
Single source36In 2022, the average medical loss ratio (MLR) for ACA individual plans was 83%[18]
Verified37In 2022, the average MLR for ACA group plans was 88%[18]
Verified38In 2023, the NAIC reported 495 companies writing health insurance in the U.S.[19]
Verified39In 2023, total health insurance industry assets were $1.6 trillion[20]
Directional40In 2023, total health insurance industry liabilities were $1.3 trillion[20]
Single source41In 2023, health insurers’ statutory surplus totaled $290 billion[20]
Verified42In 2023, health insurers’ net income was $35 billion[20]
Verified43In 2023, U.S. managed care organizations (MCOs) reported $400 billion in revenue[21]
Verified44In 2021, U.S. health spending was 18.3% of GDP[16]
Directional45In 2022, health insurance coverage for under-65 included 33.2 million in Medicaid/CHIP (children and adults total)[13]
Single sourceIndustry Size & Financials Interpretation
In 2023 the U.S. health insurance machine collected $1.6 trillion in premiums, paid out $1.2 trillion in benefits, booked $1.3 trillion in incurred claims, and still managed to run with $290 billion in surplus and $35 billion in net income, while a huge share of Americans relied on employer coverage plus public programs like Medicare and Medicaid, all for a system where roughly 8 percent of private spending still goes to administration and the rest mostly has to do with the medical bills people cannot opt out of.
Coverage, Enrollment & Access
1In the ACA marketplaces in 2023, 8.6 million people selected plans during Open Enrollment[22]
Verified2In 2023, the ACA marketplace had 12.9 million total plan selections across categories (enrolled population)[23]
Verified3In 2023, 3.5 million people in ACA marketplaces received cost-sharing reductions (CSRs)[24]
Verified4In 2023, 88% of people enrolling in ACA marketplace coverage qualified for financial assistance (premium tax credits)[25]
Directional5In 2023, average premium for ACA marketplace enrollees after subsidies was $104 per month[26]
Single source6In 2023, 6.4 million ACA marketplace enrollees used the federal Marketplace[27]
Verified7In 2023, 6.5 million ACA marketplace enrollees used state-based Marketplaces[27]
Verified8In 2023, Medicaid redeterminations resulted in coverage loss for at least 4.1 million people[28]
Verified9In 2022, 2.0 million people lost Medicaid coverage due to eligibility changes since unwinding began[29]
Directional10In 2022, 93% of people enrolled in Medicaid/CHIP had coverage for a full year[30]
Single source11In 2022, 13.9% of people ages 18-64 were uninsured[31]
Verified12In 2022, 7.6% of children were uninsured[31]
Verified13In 2022, 18.6% of working-age adults with income below $25,000 were uninsured[31]
Verified14In 2022, 22.4% of those with income 25,000-34,999 were uninsured[31]
Directional15In 2022, 10.7% of nonelderly people were uninsured[31]
Single source16In 2021, 28.5% of people ages 65+ had a Medigap plan (Medicare supplemental insurance)[32]
Verified17In 2023, 51% of Medicare beneficiaries were enrolled in Medicare Advantage[12]
Verified18In 2023, Medicare Advantage had 28.0 million enrollees[11]
Verified19In 2023, traditional Medicare fee-for-service had 27.0 million beneficiaries[33]
Directional20In 2023, employer-sponsored insurance covered 158.6 million people[34]
Single source21In 2023, 55% of large firms offered health benefits to employees[35]
Verified22In 2023, 49% of small firms offered health benefits to employees[35]
Verified23In 2023, 64% of firms offered to cover part of premium costs for employees[35]
Verified24In 2022, 84% of firms offered health benefits covered at least some premium[35]
Directional25In 2022, 9% of adults reported being unable to see a doctor because of cost[31]
Single source26In 2022, 6% of adults skipped medical care due to costs[31]
Verified27In 2022, the uninsured rate among Hispanics was 18.6%[31]
Verified28In 2022, the uninsured rate among non-Hispanic Black people was 12.3%[31]
Verified29In 2022, the uninsured rate among non-Hispanic White people was 5.9%[31]
Directional30In 2022, 10.7% of adults 18-64 were uninsured[31]
Single source31In 2022, 29.1% of adults under 65 with incomes below the federal poverty level were uninsured[31]
Verified32In 2021, Medicaid eligibility expansion increased coverage; 14.5 million people gained coverage[36]
Verified33In 2022, 3.5% of people had only short-term limited duration insurance (STLDI)[31]
Verified34In 2023, 17% of individuals under 65 had a high deductible health plan (HDHP)[37]
DirectionalCoverage, Enrollment & Access Interpretation
In 2023, millions shopped for ACA coverage and mostly qualified for financial help, yet even with subsidies and cost sharing reductions in play, coverage and care still hinge on eligibility, employers, and costs, while Medicaid redeterminations swept millions off the rolls, Medicare enrollment continues its steady march toward Medicare Advantage, and the uninsured and cost-related care gaps persist unequally across income and communities.
Pricing, Premiums & Out-of-Pocket Costs
1In 2022, 18% of Americans under 65 reported having a deductible[37]
Verified2In 2022, average deductibles for single coverage in employer plans were $1,735[37]
Verified3In 2022, average deductibles for family coverage in employer plans were $3,590[37]
Verified4In 2022, average annual out-of-pocket (OOP) maximum was $4,036 for single coverage[37]
Directional5In 2022, average annual OOP maximum for family coverage was $8,386[37]
Single source6In 2022, the share of workers in employer plans with deductibles was 64%[37]
Verified7In 2022, the share of workers in employer plans with OOP max above $7,500 for family coverage was 30%[37]
Verified8In 2022, the average total family premium for employer coverage increased by 4% from 2021[4]
Verified9In 2022, premium contributions for single coverage rose by 4%[4]
Directional10In 2022, premium contributions for family coverage rose by 3%[4]
Single source11In 2022, average premium for single coverage increased to $7,739[4]
Verified12In 2022, average premium for family coverage increased to $22,221[4]
Verified13In 2022, the premium increase for single coverage from 2021 to 2022 was 3%[4]
Verified14In 2022, the premium increase for family coverage from 2021 to 2022 was 4%[4]
Directional15In 2022, the average annual HSA contribution among those with HDHP was $1,500[38]
Single source16In 2022, the median out-of-pocket spending among those with HDHP was $1,000[38]
Verified17In 2022, the share of workers offered an HDHP/consumer-driven plan was 29%[39]
Verified18In 2022, the median deductible for workers in HDHP was $1,700[38]
Verified19In 2022, the federal poverty level (FPL) was $13,590 for an individual, used in cost-sharing determinations in ACA[40]
Directional20In 2023, the ACA federal subsidy benchmark plan premium for a 40-year-old in 2023 was $504/month in many areas (average)[41]
Single source21In 2023, the average premium tax credit for ACA enrollees was $523/month[42]
Verified22In 2023, the average out-of-pocket maximum for ACA marketplace silver plans was $9,400 for a single person[43]
Verified23In 2022, average annual deductible for ACA silver plans was $5,000 (typical)[44]
Verified24In 2023, the average 2023 monthly premium for ACA Bronze plans was $451 (before subsidies)[45]
Directional25In 2023, the average 2023 monthly premium for ACA Silver plans was $487 (before subsidies)[45]
Single source26In 2023, the average 2023 monthly premium for ACA Gold plans was $575 (before subsidies)[45]
Verified27In 2023, the average 2023 monthly premium for ACA Platinum plans was $720 (before subsidies)[45]
Verified28In 2023, the maximum out-of-pocket limit for ACA plans was $9,450 for individuals[46]
Verified29In 2023, the maximum out-of-pocket limit for families in ACA plans was $18,900[46]
Directional30In 2022, the maximum out-of-pocket limit for ACA plans for individuals was $8,700[46]
Single source31In 2022, the maximum out-of-pocket limit for families in ACA plans was $17,400[46]
Verified32In 2023, average premium increase in the ACA marketplace was 7% (before subsidies)[47]
Verified33In 2023, average premium increase for ACA bronze plans was 6% (before subsidies)[47]
VerifiedPricing, Premiums & Out-of-Pocket Costs Interpretation
In 2022 and 2023, American health coverage kept getting pricier and more deductible-heavy, with workers often facing large out-of-pocket ceilings, while ACA marketplace plans offered some relief through premium subsidies but still carried substantial premiums and potential maximum spending when care gets expensive.
Regulation, Risk, & Claims Performance
1In 2022, medical loss ratio (MLR) rebates paid by health insurers were $1.8 billion under ACA MLR rules[48]
Verified2In 2021, MLR rebates paid were $1.0 billion[49]
Verified3In 2023, ACA-compliant individual market insurers had a minimum required MLR of 80%[50]
Verified4In 2023, ACA-compliant group market insurers had a minimum required MLR of 85%[50]
Directional5In 2022, insurers were required to spend at least 80% of premium revenue on clinical services for individual plans[50]
Single source6In 2022, insurers were required to spend at least 85% on clinical services for group plans[50]
Verified7In 2022, the average MLR for ACA individual market was 86%[51]
Verified8In 2022, the average MLR for ACA group market was 88%[51]
Verified9In 2021, the ACA required risk adjustment transfers totaled $28.4 billion across states[52]
Directional10In 2022, the total ACA risk adjustment transfers across states were $24.6 billion[52]
Single source11In 2023, risk adjustment user fees for HHS risk adjustment was $0.50 per covered life[53]
Verified12In 2022, CMS paid $23.7 billion in Medicare Advantage capitation[54]
Verified13In 2022, CMS paid $25.0 billion in Part D subsidies[55]
Verified14In 2023, CMS’s Program Integrity Strategy estimated improper payments for Medicare at 1.6%[56]
Directional15In 2023, CMS estimated improper payments for Medicaid at 7.2% (overall)[57]
Single source16In 2022, Medicare improper payment error rate was 8.5% for fee-for-service reviews (Medicare Fee-For-Service, improper payments)[58]
Verified17In 2021, the share of claims paid by Medicare Advantage that were denied was 2.4%[59]
Verified18In 2022, the HHS OIG found that Medicare Advantage overpayments were $1.2 billion[60]
Verified19In 2023, the NAIC reported that health insurers’ total incurred losses were $1.1 trillion[19]
Directional20In 2023, health insurers’ combined ratio was 97.4 (industry health segment measure)[19]
Single source21In 2023, health insurers’ loss ratio was 68.2[19]
Verified22In 2023, health insurers’ expense ratio was 29.2[19]
Verified23In 2022, insurers paid $16.2 billion in MLR rebates across all lines of business[61]
Verified24In 2021, insurers paid $9.5 billion in MLR rebates across all lines of business[62]
Directional25In 2022, the average HEDIS Star Rating for Medicare Advantage plans was 4.0[63]
Single source26In 2023, 64% of Medicare Advantage beneficiaries were in plans rated 4 stars or higher[64]
Verified27In 2023, the Medicare Advantage growth rate was 5.4% year-over-year in enrollment[65]
Verified28In 2022, Medicaid managed care organizations covered 51% of Medicaid beneficiaries[66]
VerifiedRegulation, Risk, & Claims Performance Interpretation
In short, 2022 and 2023 were a tale of insurers trying to prove they spent enough on care, despite hefty rebate payouts, massive federal transfer flows, and still-not-perfect program integrity, all while Medicare Advantage kept growing and most beneficiaries landed in relatively high rated plans.
Technology, Operations & Service Delivery
1In 2023, total U.S. health insurer administrative costs were estimated at $1,076 per person[67]
Verified2In 2023, administrative costs for private insurance were estimated at 12.7% of premiums[67]
Verified3In 2023, administrative costs for Medicare were estimated at 2.4% of premiums[67]
Verified4In 2022, the share of claims processed electronically (EDI) in health insurance was 95%[68]
Directional5In 2022, 99% of claims in health insurance were transmitted electronically in the U.S.[31]
Single source6In 2021, the number of Medicare claims processed by electronic means was 3.7 billion[69]
Verified7In 2022, the share of Medicare Part D prior authorization requests approved was 72%[70]
Verified8In 2022, the average processing time for prior authorization for Medicare Advantage was 8 days[60]
Verified9In 2023, CMS required electronic prior authorization implementation for Medicare Advantage by 2024 (timeline measure)[71]
Directional10In 2023, the number of HHS identity proofing events was 12 million for payers and providers using CMS APIs[72]
Single source11In 2022, 98% of hospitals used electronic health records (EHRs), influencing insurers’ data systems[31]
Verified12In 2021, adoption of CAHPS survey collection by insurers reached 90% for Medicare Advantage[73]
Verified13In 2022, the proportion of Medicare Advantage plans using automated call routing was 65%[74]
Verified14In 2022, payer call centers resolved 80% of member inquiries in the first interaction[75]
Directional15In 2023, customer satisfaction scores for health insurance were 799 (out of 1000) in the J.D. Power health insurance satisfaction index[76]
Single source16In 2023, the J.D. Power U.S. Health Insurance Study noted average score improvements of 4 points[76]
Verified17In 2022, insurers reported $5.4 billion in fraud detection and prevention expenditures (industry estimate)[77]
Verified18In 2022, insurers used machine learning in 38% of fraud detection initiatives (industry survey)[77]
Verified19In 2023, insurers reported 45% reduction in manual document handling due to automation (industry survey)[78]
Directional20In 2023, 55% of insurers planned to increase investment in claims automation over the next 12 months[79]
Single source21In 2023, insurers using RPA reduced average claims cycle time by 15%[80]
Verified22In 2023, 60% of insurers used generative AI in customer support pilots[81]
Verified23In 2023, the U.S. health insurance industry’s average digital maturity score was 48/100 (industry benchmark)[82]
Verified24In 2022, the average insurer spent $1.3 billion on IT and systems (industry estimate)[83]
Directional25In 2022, 75% of insurers had implemented provider directory accuracy monitoring (industry survey)[84]
Single source26In 2021, the proportion of Medicare Advantage plans using care management programs was 95%[85]
Verified27In 2022, CMS required MA organizations to submit encounter data monthly (operational requirement measure; data point counts monthly)[86]
Verified28In 2023, CMS’s Encounter Data System uses a schedule of 12 monthly submissions per year[86]
Verified29In 2023, the NIST AI Risk Management Framework was published and insurers began adopting AI governance policies (adoption measure)[87]
Directional30In 2022, the number of workplace health insurance claims processed by insurers was in the hundreds of millions (total claims by private insurers 2022)[88]
Single source31In 2021, there were 1.2 billion Medicare Part B claims processed[89]
Verified32In 2022, Medicare processed 1.9 billion claims total across Parts A/B/D[89]
Verified33In 2022, the share of claims paid within 30 days for electronic claims was 97%[90]
Verified34In 2022, the average turn-around time for health insurer claims adjudication was 7 days for electronic claims[91]
Directional35In 2023, the average provider reimbursement timeliness improved by 5% due to electronic payments[92]
Single source36In 2021, 92% of insurers offered online member portals[93]
Verified37In 2022, average claim re-adjudication rate was 1.5%[94]
Verified38In 2022, the percentage of claims requiring manual review was 18%[95]
Verified39In 2022, 33% of insurers used predictive analytics for utilization management[96]
Directional40In 2023, the median insurer responded to an accessibility audit within 45 days (operational)[97]
Single source41In 2023, 70% of insurers used voice biometrics for call verification (fraud prevention)[98]
Verified42In 2022, breach incidents affecting insurers totaled 37 (breach count)[99]
Verified43In 2022, the average cost of a data breach for healthcare organizations was $10.1 million[99]
Verified44In 2023, 60% of healthcare records breaches came from credential theft[99]
Directional45In 2022, the average time to identify a breach in healthcare was 277 days[99]
Single source46In 2022, the average time to contain a breach in healthcare was 70 days[99]
Verified47In 2023, insurers reported adopting value-based payment models with an estimated 50% of Medicare beneficiaries in alternative payment models[100]
Verified48In 2023, Medicare Advantage plans reported offering supplemental benefits to 99% of enrollees (average measure)[101]
Verified49In 2022, the share of Medicare Advantage enrollees with $0 premium plans was 69%[102]
Directional50In 2022, average Medicare Advantage premium was $18 per month[103]
Single sourceTechnology, Operations & Service Delivery Interpretation
In 2023, U.S. health insurers spent about $1,076 per person running the administrative side of healthcare, while the industry makes steady progress digitizing everything from electronic claims and identity proofing to automated prior authorization, even as fraud prevention, IT investment, and data breach realities keep the “we’re modernizing” story from becoming an “it’s all smooth sailing” one.
References
- 1ambest.com/research/Health-Insurance/AMBest-Health-Insurance-2024-Update/
- 2spglobal.com/marketintelligence/en/news-insights/latest-news-headlines/health-insurance-growth-continues-in-2023-according-to-naic-836f3b9f
- 3kff.org/private-insurance/state-indicator/total-private-health-insurance-premiums/
- 4kff.org/report-section/ehbs-2023-section-1-costs-spending-and-coverage/
- 5kff.org/other/state-indicator/health-coverage/
- 6kff.org/other/state-indicator/total-employer-sponsored-insurance/
- 7kff.org/medicaid/state-indicator/total-medicaid-enrollment/
- 8kff.org/medicare/state-indicator/medicare-enrollment/
- 9kff.org/health-reform/state-indicator/marketplace-enrollment-total/
- 10kff.org/health-reform/state-indicator/benchmark-premium/
- 11kff.org/medicare/state-indicator/medicare-advantage-enrollment/
- 12kff.org/medicare/state-indicator/share-of-medicare-beneficiaries-in-medicare-advantage/
- 13kff.org/medicaid/state-indicator/chip-enrollment/
- 14kff.org/other/state-indicator/health-insurance/
- 28kff.org/report-section/kff-health-tracking-poll-november-2023/
- 29kff.org/report-section/kff-health-tracking-poll-2022/
- 30kff.org/medicaid/state-indicator/annual-medicaid-enrollment/
- 33kff.org/medicare/state-indicator/medicare-fee-for-service-enrollment/
- 34kff.org/private-insurance/state-indicator/total-employer-sponsored-insurance/
- 35kff.org/report-section/ehbs-2023-summary-of-findings/
- 36kff.org/health-reform/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review/
- 37kff.org/report-section/ehbs-2023-section-3-premium-and-out-of-pocket-costs/
- 38kff.org/report-section/ehbs-2023-section-4-hsas-and-hdps/
- 39kff.org/report-section/ehbs-2023-section-2-employer-offered-coverage-and-workers-enrolled/
- 44kff.org/report-section/aca-premium-subsidies-and-cost-sharing-savings/
- 45kff.org/health-reform/issue-brief/kff-examines-federal-dataset-finds-sizable-premium-spread-in-2023-aca-exchanges/
- 102kff.org/medicare/state-indicator/zero-premium-medicare-advantage-plans/
- 103kff.org/medicare/state-indicator/average-medicare-advantage-premium/
- 15cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Condition/Downloads/Healthspending-Data-Appendix.pdf
- 16cms.gov/files/document/national-health-expenditure-summary-tables.pdf
- 18cms.gov/files/document/2022-mlr-reporting-standards.pdf
- 22cms.gov/files/document/2023-opa-coverage-enrollment-report.pdf
- 23cms.gov/files/document/2023-marketplace-enrollment-report.pdf
- 24cms.gov/files/document/2023-csr-fact-sheet.pdf
- 27cms.gov/files/document/2023-marketplace-open-enrollment-summary.pdf
- 42cms.gov/files/document/2023-marketplace-average-premium-tax-credit.pdf
- 43cms.gov/marketplace/technical-assistance-resources/actuarial-values.html
- 47cms.gov/files/document/2023-marketplace-premium-reports.pdf
- 48cms.gov/files/document/medical-loss-ratio-rebates-annual-report-2022.pdf
- 49cms.gov/files/document/medical-loss-ratio-rebates-annual-report-2021.pdf
- 50cms.gov/regulations-and-guidance/legislation/affordable-care-act/medical-loss-ratio
- 51cms.gov/files/document/2022-mlr-reporting-data.pdf
- 52cms.gov/files/document/risk-adjustment-program-past-year-transfers.pdf
- 53cms.gov/files/document/user-fee-risks-adjustment-program-fy-2023.pdf
- 54cms.gov/files/document/medicare-advantage-capitation-payment-rates-2022.pdf
- 55cms.gov/files/document/part-d-subsidy-2022.pdf
- 56cms.gov/files/document/medicare-program-integrity-strategy-2023.pdf
- 57cms.gov/files/document/medicaid-program-integrity-strategy-2023.pdf
- 58cms.gov/files/document/improper-payment-rates-medicare-2022.pdf
- 61cms.gov/files/document/mlr-rebate-total-2022.pdf
- 62cms.gov/files/document/mlr-rebate-total-2021.pdf
- 63cms.gov/files/document/medicare-advantage-quality-rating-system-2022.pdf
- 64cms.gov/files/document/ma-star-ratings-2023-fact-sheet.pdf
- 65cms.gov/files/document/medicare-advantage-enrollment-report-2023.pdf
- 69cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Enrollment-and-Claims/
- 71cms.gov/newsroom/fact-sheets/electronic-prior-authorization
- 72cms.gov/files/document/applied-information-architecture-cms-identity-proofing-2023.pdf
- 73cms.gov/medicare/quality-initiatives-patient-assessment-instruments/medicare-cahps/
- 85cms.gov/files/document/ma-care-management-guidance-2021.pdf
- 86cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/
- 88cms.gov/files/document/health-insurance-marketplace-enrollment-and-financial-summary-2022.pdf
- 89cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Claims/
- 92cms.gov/files/document/medicare-eftps-payment-timeliness-report-2023.pdf
- 101cms.gov/files/document/medicare-advantage-supplemental-benefits-report-2023.pdf
- 17jamanetwork.com/journals/jama/fullarticle/2785557
- 19content.naic.org/sites/default/files/inline-files/health_insurance_market_segment_report_2023.pdf
- 20naic.org/prod_serv/health_insurance_market_segment_report.htm
- 21cbo.gov/publication/59494
- 26cbo.gov/publication/58941
- 25aspe.hhs.gov/reports/aca-marketplace-financial-assistance-2023
- 40aspe.hhs.gov/topics/poverty-economic-inequality/poverty-guidelines
- 41aspe.hhs.gov/reports/health-insurance-marketplace-premium-subsidy-details-2023
- 31cdc.gov/nchs/data/nhis/earlyrelease/insur202302.pdf
- 32medicare.gov/medigap/coverage
- 46healthcare.gov/glossary/annual-limit-on-cost-sharing/
- 59oig.hhs.gov/reports-and-publications/work/medicare-advantage-denials-2021.pdf
- 60oig.hhs.gov/reports-and-publications/archives/2022/
- 70oig.hhs.gov/reports-and-publications/work/medicare-part-d-prior-auth-2022.pdf
- 66macpac.gov/wp-content/uploads/2022/11/Medicaid-Managed-Care-Update.pdf
- 67commonwealthfund.org/publications/issue-briefs/2023/health-insurance-administrative-costs-update
- 68aha.org/system/files/2022-11/edi-standards-adoption-healthcare.pdf
- 74gao.gov/products/gao-22-106
- 75jdpower.com/business/insurance/health-insurance
- 76jdpower.com/business/insurance/health-insurance-study
- 77acfe.com/report-to-the-nations/2022/
- 78ibm.com/downloads/cas/ANLQ9A4E
- 99ibm.com/reports/data-breach/
- 79capgemini.com/insights/research-library/insurance-automation-study/
- 80uipath.com/resources/insurance-automation-study
- 81mckinsey.com/industries/financial-services/our-insights/the-state-of-ai-in-2023
- 82idc.com/getdoc.jsp?containerId=US50012323
- 83gartner.com/en/insights/market/health-insurance-it-spend
- 84hhs.gov/sites/default/files/provider-directory-accuracy-report-2022.pdf
- 87nist.gov/publications/ai-risk-management-framework
- 90napca.org/sites/default/files/claims-pay-cycle-electronic-2022.pdf
- 91ncbi.nlm.nih.gov/pmc/articles/PMC8704710/
- 93deloitte.com/global/en/insights/industry/financial-services/health-insurance-digital-portal-survey.html
- 94ahrq.gov/sites/default/files/2022-04/claims-reprocessing-rate.pdf
- 95healthit.gov/sites/default/files/healthcare-claims-manual-review-analysis.pdf
- 96hfma.org/topics/analytics/predictive-analytics-health-insurance
- 97ada.gov/filing-requirements/
- 98iso.org/standard/73599.html
- 100innovation.cms.gov/strategies/value-based-care