Medicare
Prescription Drugs
High-Cost Drugs
FDA’s Approval of Biogen’s New Alzheimer’s Drug Has Huge Cost Implications for Medicare and Beneficiaries
FDA approval of Aduhelm, a medication for Alzheimer’s with an annual price tag of $56,000, raises hopes for patients and their families — along with serious cost concerns for patients and payers, particularly Medicare. In 2017 nearly 2 million Medicare beneficiaries used one or more of the Alzheimer’s treatments covered under Part D. If just one-quarter are prescribed Aduhelm, spending for the drug could be nearly $29 billion a year.
New & Noteworthy
- Trust FUnd
FAQs on Medicare Financing and Trust Fund Solvency
The Medicare Hospital Insurance (HI) trust fund is projected to be depleted in 2026. The projected deficit amounts to $517 billion between 2026 and 2031. Our FAQs answer key questions about Medicare financing and trust fund solvency. In the 30 years prior to 2021, the trust fund has come within five years of depletion only twice – in 1996 and 1997. To date, Congress has never allowed the trust fund to be fully depleted. - Health costs
Limiting Private Insurance Reimbursement to Medicare Rates Would Reduce Health Spending by About $350 Billion in 2021
Total health care spending for people with private health insurance would be an estimated $352 billion lower in 2021 if private insurers used Medicare rates to pay hospitals and other health care providers, rather than the substantially higher rates they currently pay, our analysis finds. - Part D
Options to Make Medicare More Affordable For Beneficiaries Amid the COVID-19 Pandemic and Beyond
Medicare covers more than 60 million Americans, but gaps in coverage and high cost-sharing requirements can make health care difficult to afford. We examined policy options to make Medicare more affordable, including the likely cost & how many people would be helped. - Telehealth
Medicare and Telehealth: Coverage and Use During the Pandemic and Options for the Future
Just over 1 in 4 Medicare beneficiaries had a telehealth visit with a doctor or other health professional between the summer and fall of 2020. Once limited to beneficiaries in rural areas, coverage of telehealth services by traditional Medicare has undergone rapid expansion during the pandemic. More limited availability would return when the public health emergency ends without a rules change. - Affordability
Cost-Related Problems Are Higher Among Privately-Insured Adults 50 to 64 than Medicare-Covered Adults 65 and Older
A somewhat larger share of privately-insured adults ages 50 to 64 (16%) than Medicare-covered adults ages 65+ (11%) report having cost-related problems, defined as delaying or forgoing medical care due to costs or having problems paying medical bills.
Coronavirus
Vaccines
Vaccination Rates Are Relatively High for Older Adults Overall, But Lag in Some Counties, Especially in High Poverty Areas and in the South
Older Americans, a group hit disproportionately hard by the coronavirus pandemic, are now among those in the U.S. who are most likely to have been vaccinated against COVID-19. Nevertheless, our new county-level analysis finds that rates of fully vaccinated older adults vary considerably across the country. Rates tend to be lower in counties with a higher share of seniors in poverty, counties located in the South, and counties with a higher share of adults who voted for Trump.
Medicare Open Enrollment
Data Note
More Than Half of All People on Medicare Do Not Compare Their Coverage Options Annually
Fifty-seven percent of Medicare beneficiaries do not review or compare their coverage options annually – a decision that can lead to unanticipated costs or coverage disruptions as beneficiaries pick Part D stand-alone drug plans and Medicare Advantage plans. Medicare’s annual open enrollment period runs from October 15 through December 7.
Medicare advantage statistics
Latest Polling59%
of Medicare Advantage enrollees are in plans operated by UnitedHealthcare, Humana, or BlueCross BlueShield affiliates in 2019. (2019 Issue Brief)
29%
of new Medicare beneficiaries enrolled in Medicare Advantage plans during their first year on Medicare in 2016. (2019 Issue Brief)
34%
of all Medicare beneficiaries (22 million people) are enrolled in Medicare Advantage plans. (2019 Issue Brief)
62%
of the 22 million Medicare Advantage enrollees in 2019 are in in HMOs, with the rest in local or regional PPOs. (2019 Fact Sheet)
The Essentials
- Basics
An Overview of Medicare Coverage
Medicare plays a key role in providing health care and financial security to more than 60 million older people and younger people with disabilities. - Supplemental Coverage
A Snapshot of Sources of Coverage Among Medicare Beneficiaries in 2018
This data note explores sources of coverage among beneficiaries in Medicare and the demographic characteristics of people with different types of coverage, based on data from the 2018 Medicare Current Beneficiary Survey. - Disparities
Racial and Ethnic Health Inequities and Medicare
This chart collection examines the characteristics, experiences, and outcomes of the Medicare population by race and ethnicity. It includes data to describe demographics, health status and disease prevalence, health coverage, access to care and service utilization, and health outcomes, including data pertaining to disparities related to COVID-19. - medicare part d
An Overview of the Medicare Part D Prescription Drug Benefit
- quiz
How Much Do You Know About Medicare?
Take this quiz to find out how much you know about Medicare, the people it serves, the benefits it covers, and its financial status.
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Expanding Insurance Coverage Is Top Priority for New Medicare-Medicaid Chief
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Caring for an Aging Nation
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KHN’s ‘What the Health?’: The Return of the Public Option
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Is Your Living Room the Future of Hospital Care?