Methodology
- Source: CMS Transparency in Coverage public use files, PY2023-PY2026 (claims years 2021-2024), downloaded from data.healthcare.gov.
- Scope: individual-marketplace QHPs on HealthCare.gov states. State-based marketplaces do not report to this file.
- Denial rate = denied in-network claims / received in-network claims, at issuer level. Insurers under 1,000 claims are excluded from rankings.
- Values suppressed by CMS (*, **) are treated as missing, never zero.
- Denial reasons are plan-level reports; CMS does not link reasons to total claims, so reason shares are of reported reasons.
- Premium and deductible pages: CMS QHP Landscape files PY2025 and PY2026. Figures are simple averages across plans of the Adult Individual Age 27 premium (the CMS benchmark age), not enrollment-weighted. HealthCare.gov states only; state-based marketplaces do not report to this file.
- Subsidy estimator: 2026 Applicable Percentage Table from IRS Rev. Proc. 2025-25 (2.10% to 9.96%, linearly interpolated within bands per 26 CFR 1.36B-3(g); the enhanced subsidies expired after 2025, so the 400% FPL cliff applies again). 2026 eligibility uses the 2025 HHS poverty guidelines ($15,650 single, $32,150 family of four; Alaska and Hawaii variants). The benchmark premium is approximated with the state's median silver plan premium at your age from the PY2026 Landscape file; the actual benchmark (second-lowest-cost silver plan) is county and rating-area specific. Income is assumed from the selected bracket midpoint; the real credit uses MAGI and is settled on your tax return.
- All rates on this site are computed in your browser from the raw reported counts.
Frequently asked
How is a claim denial rate calculated?
Denied in-network claims divided by received in-network claims, per insurer per year, from the raw counts each insurer files with CMS. Issuers under 1,000 claims are excluded from rankings.
Why does my insurer's own number differ?
Insurers sometimes quote rates across all plan types including employer plans, or use different numerators such as claim lines instead of claims. This site uses the marketplace in-network counts from the CMS file, applied the same way to every insurer.
Is the data updated automatically?
The pages are rebuilt from CMS public use files. When CMS publishes new filing years, the generator re-runs and every page's rates and years refresh from the new data.
What are the asterisks in CMS files?
CMS suppresses values marked * or ** for privacy. This site treats suppressed values as missing data, never as zero.