Medicare

While Congress considers capping Medicare Part D out-of-pocket drug costs, people in traditional Medicare & Medicare Advantage also can face high costs for physician-administered drugs covered under Part B. We analyze cost-sharing liability for these drugs in traditional Medicare and cost-sharing requirements in Medicare Advantage plans. Data limitations preclude us from analyzing actual out-of-pocket costs paid by beneficiaries who used Part B drugs.

Older adults have suffered more illness and death from COVID-19 than any other group. KFF’s Kaiser Health News (KHN) and The John A. Hartford Foundation explored how they are faring in the pandemic in a 90-minute interactive web event on Feb. 23.
The panel included African American, Latino, White, and LGBTQ+ older adults. Among them was a nursing home resident in Maryland, a couple living in a retirement community in Pennsylvania, a man with Alzheimer’s disease in Nevada, a divorced couple who live together and help each other in North Carolina, a single woman living alone in Minnesota, an activist who cares for his bedbound wife in Dallas, and a woman who lives in affordable housing in New York City.

Our analysis finds that 3,834 Medicare Advantage plans will be available across the U.S. in 2022 – an increase of 8 percent from 2021 and the largest number of plans available in more than a decade. More than 26 million Medicare beneficiaries (42% of all beneficiaries) are in Medicare Advantage plans, which are mostly HMOs and PPOs offered by private insurers. A typical beneficiary will be able to choose from 39 plans in their area but the number varies greatly across the country.
We’ve got an overview of the Medicare Advantage and Medicare Part D marketplace for 2022, including the latest data and key trends over time. Medicare’s open enrollment period began Oct. 15 and runs through Dec. 7.
> Read the news release
> Medicare Part D: A First Look at Medicare Prescription Drug Plans in 2022

Many Medicare beneficiaries face high annual out-of-pocket costs for dental and hearing care — services that generally aren’t covered in traditional Medicare, but typically are covered by Medicare Advantage plans though the scope and value of these benefits vary.
Our analysis shows that, among beneficiaries who used each type of service, average annual out-of-pocket spending was $914 for hearing care and $874 for dental care in 2018, but considerably less ($230) for vision care. Among those who were in the top 10 percent in terms of their out-of-pocket costs for such services, 2.7 million beneficiaries spent $2,136 or more on their dental care, while 360,000 beneficiaries spent $3,600 or more on hearing services. 
Beneficiaries can face high out-of-pocket costs whether they are in traditional Medicare or privately-run Medicare Advantage plans.

Rates of cost-related problems are higher among beneficiaries in Medicare Advantage than in traditional Medicare with supplemental coverage, but highest among beneficiaries in traditional Medicare without supplemental coverage. Among Black beneficiaries specifically, a larger share of those in Medicare Advantage reported cost-related problems than those in traditional Medicare (32% vs. 24%). The rate of cost-related problems was lower still among the subset of Black beneficiaries in traditional Medicare who had Medicaid or other sources of supplemental insurance (20%).