Claims Denials and Appeals in ACA Marketplace Plans in 2024

(Authors: Michelle Long, Justin Lo, and Kaye Pestaina for The Kaiser Family Foundation Published: Mar 24, 2026)

The impact of claims denials is widely recognized by lawmakers and the public. According to a January 2026 KFF poll, two-thirds (66%) of insured adults believe delays and denials of health care services by health insurance companies are a “major problem.” One-third (33%) of insured adults say they have had a health insurance company deny coverage for a certain health care service or medication prescribed by their doctor in the past two years. The Affordable Care Act (ACA) requires insurers to report transparency data for all non-grandfathered health plans sold on and off the Marketplace, including fully-insured and self-funded employer health plans. Partial implementation of this federal requirement began with the 2015 plan year; however, it has so far been limited to qualified health plans (QHPs) offered on the federally facilitated Marketplace, HealthCare.gov (including state-based Marketplaces that rely on HealthCare.gov for eligibility and enrollment functions). It does not yet include QHPs offered on state-based Marketplaces or group health plans. Continue reading here…

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