This issue brief explains how behavioral health parity applies in the Medicaid program, including the major provisions of the Centers for Medicare and Medicaid Services’ (CMS) April 10, 2015 proposed regulations, and identifies key policy issues at the intersection of behavioral health parity and Medicaid.
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Medicare’s Drug Benefit Is Firmly-Established After Its First Decade, With Flat Premiums in Recent Years but Higher Cost-Sharing Over Time
With Medicare Part D nearing the end of its tenth year, the program — which now provides drug coverage to 72 percent of all Medicare beneficiaries — has experienced no growth in average premiums in recent years but some notable increases in cost-sharing, according to a new report from the…
The Patient Protection and Affordable Care Act (ACA) requires most private plans to provide coverage for women’s preventive health care, including all prescribed FDA-approved contraceptive services, without cost sharing. To better understand how this provision is being implemented by health plans, Kaiser Family Foundation (KFF) staff, with the Lewin Group, reviewed the insurance plan coverage policies for 12 prescribed contraceptive methods (excluding oral contraceptives). This report presents information from 20 different insurance carriers in five states (California, Georgia, Michigan, New Jersey, and Texas) about how they are applying reasonable medical management (RMM) techniques in their coverage of women’s contraceptive services. The different forms of female birth control reviewed in this report include the contraceptive ring, the patch, injections, implants, intrauterine devices (IUDs), and sterilization.
The Affordable Care Act (ACA) requires most private health insurance plans to provide coverage for a broad range of preventive services, including most contraceptives for women. This policy was at the center of a Supreme Court case brought forward by for-profit corporations (Hobby Lobby and Conestoga) that successfully claimed that the contraceptive coverage requirement violated their religious rights. Last month, the Supreme Court agreed to hear yet another challenge (Zubik v Burwell) to the contraceptive coverage requirement, this time brought by nonprofit corporations, claiming that the accommodation established by the federal government for religiously affiliated nonprofit employers with objections to contraception violates their religious rights.
This analysis focuses on out-of-pocket drug costs for Medicare Part D enrollees in 2016 for specialty, brand, and generic drugs. Part D drug plans differ considerably in the drugs they list on their formularies, their use of formulary tiers, and the level and structure of cost sharing applied to those tiers. Plan decisions affect different beneficiaries in different ways, depending on the drugs they use. The financial consequences for Part D plan enrollees can be substantial. In addition to examining costs for common drugs, we also examine profiles of multiple drugs for several hypothetical Part D enrollees.
One in 10 Larger Nonprofits Have Sought an ‘Accommodation’ to the ACA Contraceptive Coverage Rule, Analysis Finds
As the U.S. Supreme Court gears up to hear a new round of legal challenges to the ACA’s contraceptive coverage requirement, a new Kaiser Family Foundation data note finds 10 percent of nonprofits with more than 1,000 employees have requested an “accommodation” to the health law’s birth control requirement. Overall,…
Although a Small Share of Medicare Part D Enrollees Take Specialty Drugs, A New Analysis Finds Those Who Do Can Face Thousands of Dollars in Out-of-Pocket Drug Costs Despite Plan Limits on Catastrophic Expenses
Some Medicare Part D enrollees can expect to pay thousands of dollars out-of-pocket for a single specialty drug in 2016, even though Part D plans provide substantial protection against catastrophic costs, according to a new analysis from the Kaiser Family Foundation. The findings illustrate how high prescription drug prices, one…
Brief Explains Why Medicare Part B Premiums Will Increase by 16 percent, not 52 percent, in 2016 for 3 in 10 Beneficiaries Due to the Recent Budget Deal
As a result of the recently enacted budget deal in Congress, the 2016 Medicare Part B monthly premium will be $121.80, increasing by 16 percent over the 2015 amount—far lower than the increase initially projected by the Medicare actuaries, a new brief from the Kaiser Family Foundation explains. The Part…
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey
To date, there has been little research providing a quantitative look at the causes of medical bill problems and the impacts they have on people’s families, their finances, and their access to health care. To fill this gap, the Kaiser Family Foundation and The New York Times conducted an in-depth survey with 1,204 adults ages 18-64 who report that they or someone in their household had problems paying or an inability to pay medical bills in the previous 12 months.
Paying a Visit to the Doctor: Current Financial Protections for Medicare Patients When Receiving Physician Services
As the Congress continues to work on reforming Medicare payments for physician services, a new Kaiser Family Foundation brief examines key provisions in current law that help provide safeguards and financial protections for beneficiaries when they visit their doctor, and explains how potential changes could affect beneficiaries, providers, and the…