Medicare Advantage Insurers Report Much Higher Gross Margins Per Enrollee Than Insurers in Other Markets February 28, 2023 News Release A new analysis of health insurers’ 2021 financial data shows that insurers continue to report much higher gross margins per enrollee in the Medicare Advantage market than in other health insurance markets. The analysis examines insurers’ financial data in the Medicare Advantage, Medicaid managed care, individual (non-group), and fully insured…
Health Insurer Financial Performance in 2021 February 28, 2023 Issue Brief Using health insurer financial data for 2021, we find that Medicare Advantage insurers reported gross margins that were at least twice as high as those reported by insurers in the individual/non-group, fully-insured group/employer, and Medicaid managed care markets. The four markets report similar simple medical-loss-ratios.
CMS Prior Authorization Proposal Aims to Streamline the Process and Improve Transparency February 21, 2023 Issue Brief This brief explains a new proposed federal regulation aimed at reducing administrative hassles involved in obtaining prior authorization for care and sets out key policy questions, including how the proposal could impact the patient experience and data privacy.
Is the Biden Administration Proposing Cuts to Medicare Advantage? February 17, 2023 Blog Recent announcements by the Administration to improve the accuracy of payments and improve program integrity of Medicare Advantage are unlikely to have a major impact on the program, the insurance industry or beneficiaries, given relatively generous payments to plans and the robustness of the market for private Medicare plans.
The End of the COVID-19 Public Health Emergency: Details on Health Coverage and Access February 3, 2023 Blog This post provides an overview of how health care coverage and access will and won’t change when the public health emergency ends on May 11, including a discussion of COVID-19 vaccines, tests, and treatments, and telemedicine.
Medicare Advantage Plans Denied 2 Million Prior Authorization Requests in 2021, About 6% of Such Requests February 2, 2023 News Release Medicare Advantage plans denied two million prior authorization requests for health care services in whole or in part in 2021, or about six percent of the 35 million requests submitted on behalf of enrollees that year, a new KFF analysis finds. Prior authorization is intended to ensure that health care…
Over 35 Million Prior Authorization Requests Were Submitted to Medicare Advantage Plans in 2021 February 2, 2023 Issue Brief We analyze data from CMS to examine the number and outcome of Medicare Advantage prior authorization requests in 2021, overall and by firm.
Two KFF Analyses Explore the Demographics of People Jointly Enrolled in Medicare and Medicaid As Well As Program Enrollment and Spending for This Population January 31, 2023 News Release The 12.5 million people who are jointly enrolled in Medicare and Medicaid include some of the poorest individuals in the U.S. with some of the highest health needs, requiring disproportionately high spending from both programs to support them. Two new KFF analyses examine the demographics of this population as well…
Enrollment and Spending Patterns Among Medicare-Medicaid Enrollees (Dual Eligibles) January 31, 2023 Issue Brief This brief examines national and state-level data on enrollment and spending for Medicare-Medicaid enrollees using the 2019 and 2020 Medicare Beneficiary Summary Files and the 2019 Transformed Medicaid Statistical Information System (T-MSIS). Spending data for Medicare includes beneficiaries in traditional Medicare only, since spending data for beneficiaries enrolled in Medicare Advantage plans are unavailable. State-level data on Medicare-Medicaid enrollment and spending are available through KFF’s State Health Facts.
A Profile of Medicare-Medicaid Enrollees (Dual Eligibles) January 31, 2023 Issue Brief This brief examines the demographic, socioeconomic, and health characteristics of Medicare-Medicaid enrollees using the 2020 Medicare Current Beneficiary Survey. It highlights the diversity within the Medicare-Medicaid population and how Medicare-Medicaid enrollees differ from all other Medicare beneficiaries.