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How Much Is Enough? Out-of-Pocket Spending Among Medicare Beneficiaries: A Chartbook

This new analysis and chartbook examines out-of-pocket spending among Medicare beneficiaries, including spending on health and long-term care services and insurance premiums, using the most current year of data available from a nationally representative survey of people on Medicare. It explores which types of services account for a relatively large share of out-of-pocket spending, which groups of beneficiaries (including by age, gender, health status, and chronic conditions) are especially hard hit by high out-of-pocket costs, and trends in out-of-pocket spending between 2000 and 2010.

Adding an Out-of-Pocket Spending Maximum to Medicare: Implementation Issues and Challenges

In an effort to simplify Medicare’s cost-sharing requirements, provide beneficiaries with catastrophic protection, and achieve program savings, some have proposed to restructure Medicare’s benefit design. Several recent proposals would create a unified deductible for Medicare Parts A and B, simplify cost-sharing requirements above the deductible, and add an annual limit on beneficiary out-of-pocket spending—a benefit feature typical of larger employer plans, but lacking in traditional Medicare. This issue brief describes the options for adding an out-of-pocket spending limit to Medicare and examines the operational issues that could arise in implementing both a uniform and an income-based out-of-pocket spending limit. Because the implementation of an income-related out-of-pocket maximum would pose somewhat greater complexity for Medicare, the operational issues associated with this approach are discussed in greater detail.

Medicare Part D in Its Ninth Year: The 2014 Marketplace and Key Trends, 2006-2014

This report presents findings from an analysis of the Medicare Part D marketplace in 2014 and changes in features of the drug benefit offered by Part D plans since 2006. It examines the latest information and trends related to Part D enrollment and plan availability, premiums, benefit design and cost sharing, pharmacy networks, the Low-Income Subsidy Program, and plan performance ratings.

Employer-Sponsored Family Health Premiums Rise 3 Percent in 2014

Average Annual Family Premiums Stand at $16,834, With Workers Contributing $4,823 Workers Now Face Deductibles Averaging $1,217, Up 47 Percent Since 2009 Menlo Park, Calif. – Average annual premiums for employer-sponsored family health coverage reached $16,834 this year, up 3 percent from last year, continuing a recent trend of modest increases,…

2014 Employer Health Benefits Survey

This annual Employer Health Benefits Survey (EHBS) provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, and other relevant information. The 2014 EHBS survey finds average family health premiums rose 3 percent in 2014, relatively modest growth by historical standards.

Paying a Visit to the Doctor: Current Financial Protections for Medicare Patients When Receiving Physician Services

This issue brief explains provisions in current law that shield beneficiaries from unexpected and confusing charges when they see physicians and practitioners—namely, the participating provider program, limitation on balance billing, and conditions on private contracting for doctors who opt out of Medicare or join “concierge” practices. It also analyzes the implications of modifying these provisions for beneficiaries, providers, and the Medicare program.

Medicare Part D Prescription Drug Plans: The Marketplace in 2013 and Key Trends, 2006-2013

This report presents findings from an analysis of the Medicare Part D marketplace in 2013 and changes in drug coverage and costs since 2006. It presents key findings related to Medicare drug plan availability, enrollment, premiums, low-income subsidies, the coverage gap, benefit design, cost sharing, formularies, and utilization management, based on data from CMS for all plans participating in Part D. The analysis was conducted jointly by researchers at Georgetown University, the Kaiser Family Foundation and the National Opinion Research Center at the University of Chicago.

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.