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Development of the Financial Alignment Demonstrations for Dual Eligible Beneficiaries: Perspectives from National and State Disability Stakeholders

This issue brief provides an early snapshot into disability community perspectives on state design and implementation efforts related to the new financial alignment demonstrations for beneficiaries dually eligible for Medicare and Medicaid, with an emphasis on non-elderly beneficiaries and those who use long-term services and supports.

Comparison of Consumer Protections in Three Health Insurance Markets: Medicare Advantage, Qualified Health Plans and Medicaid Managed Care Organizations

This report examines similarities and differences in federal consumer protection standards for Medicare Advantage (MA) plans, Qualified Health Plans (QHPs), and Medicaid Managed Care Organizations (MCOs). It focuses on rules established at the federal level, though some states have chosen to go above the federal minimums and impose additional requirements for QHPs and Medicaid MCOs.

Medicare’s Income-Related Premiums: A Data Note

This data note presents new information to help set a context for understanding the implications of recent changes to Medicare’s income-related premiums incorporated in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a new law to repeal and replace Medicare’s Sustainable Growth Rate (SGR) formula for physician payments. It describes current requirements with respect to the income-related premiums under Medicare Part B and Part D, including the number and share of Medicare beneficiaries who are estimated to pay income-related premiums and revenues raised from the income-related premium, based on data from the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary (OACT). It also explains the recently enacted changes in MACRA that will affect some higher-income people on Medicare who are already paying income-related premiums, beginning in 2018.

Reading the Stars: Nursing Home Quality Star Ratings, Nationally and by State

This issue brief presents national and state-level analysis of nursing homes based on the Five-Star Quality Rating System, recently updated by the Centers for Medicare and Medicaid Services (CMS) to help consumers compare nursing homes when selecting one for themselves or their family members. The issue brief finds that more than one-third (36%) of the nation’s 15,500 nursing homes certified by Medicare or Medicaid received relatively low ratings of 1 or 2 stars (out of a possible 5 stars). In 11 states, at least 40 percent of nursing homes in the state have 1- or 2-star ratings. In 23 states, however, at least half of the nursing homes have 4- or 5- star ratings. This issue brief discusses relevant policy considerations regarding nursing home quality—a serious issue in light of the vulnerability of the nursing home population and recent reports of problems arising from inadequate staffing, fire safety hazards, and substandard care.

10 FAQs: Medicare’s Role in End-of-Life Care

About eight of 10 of the 2.6 million people who died in the US in 2014 were people on Medicare, making Medicare the largest insurer of health care provided during the last year of life. These Frequently Asked Questions explain Medicare’s role in or coverage of end-of-life care, advance care planning, advance directives, and hospice care. They also provide information on Medicare spending on end-of-life care, changes to the physician fee schedule, and how related issues arose prior to the passage of the Affordable Care Act.

Poverty Among Seniors: An Updated Analysis of National and State Level Poverty Rates Under the Official and Supplemental Poverty Measures

This brief presents data on poverty rates among seniors, as context for understanding the implications of potential changes to federal and state programs that help to bolster financial security among older adults. The analysis presents national and state-level poverty rates among people ages 65 and older, based on two measures from the U.S. Census Bureau, using data from the 2014 Current Population Survey (CPS): the official poverty measure and the Supplemental Poverty Measure.

Medicare Advantage 2015 Spotlight: Enrollment Market Update

This Data Spotlight reviews national and state-level enrollment trends as of March 2015 and examines variation in enrollment by plan type and firm. It analyzes the most recent data on premiums, out-of-pocket limits, Part D cost-sharing for drugs, and plans’ quality ratings for Medicare Advantage enrollees.

Medicare Advantage

This fact sheet provides an overview of the Medicare Advantage program, describes program changes made by the new health reform law in plan participation and beneficiary enrollment, presents data on benefits and premiums, and explains changes in Medicare payments to participating plans.

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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.