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  • Medicare Advantage Insurers Made Nearly 53 Million Prior Authorization Determinations in 2024

    Issue Brief

    Nearly 53 million prior authorization requests were submitted to Medicare Advantage insurers on behalf of Medicare Advantage enrollees in 2024, of which 4.1 million (7.7%) were denied. Just 11.5% of denied requests were appealed, though 80.7% of appeals overturned the initial denial in Medicare Advantage. Substantially fewer prior authorization requests were made in traditional Medicare, reflecting the small number of services subject to prior authorization requirements.

  • New Trump Administration Proposals Would Further Limit Gender Affirming Care for Young People by Restricting Providers and Reducing Coverage

    Issue Brief

    This brief examines two proposed federal rules that would further restrict youth access to gender affirming care. One rule would change the hospital Conditions of Participation (CoPs) which would prohibit most Medicare and Medicaid enrolled hospitals from providing certain types of gender affirming medical care for young people and the other would prohibit federal Medicaid or CHIP funds from covering this care. The rules have a 60-day comment period, do no take immediate effect, and…

  • Trump Administration Actions to Curb Data Collection Related to Sexual Orientation and Gender Identity (SOGI)

    Issue Brief

    This brief describes Trump Administration efforts to scale back or modify data collection on sexual orientation and gender identity variables in federal surveys. It specifically focuses on changes in three national surveys that are representative of these efforts: the National Health Interview Survey (NHIS), the Medicare Current Beneficiary Survey (MCBS), and the National Crime Victimization Survey (NCVS).

  • Medicare Advantage 2026 Spotlight: A First Look at Plan Offerings

    Issue Brief

    This brief provides an overview of the Medicare Advantage plans that are available for 2026 and key trends over time. In 2026, the average Medicare beneficiary has a choice of 32 Medicare Advantage prescription drug (MA-PD) plans, two fewer than the 34 in 2025. Virtually all Medicare Advantage plans for 2026 provide multiple extra benefits like vision, hearing, and dental benefits, similar to last year.

  • Chart Reviews Increase Payments to Medicare Advantage Insurers for 1 in 6 Enrollees

    Issue Brief

    Using Medicare Advantage encounter data, this analysis finds that 62% of Medicare Advantage enrollees have at least one chart review record and that diagnoses added from chart reviews increase payments from CMS to insurers for 17% of enrollees. The use of chart reviews varies across the largest Medicare Advantage insurers.

  • Medicare Beneficiaries Are Not Luddites

    From Drew Altman

    In a new column, President and CEO Dr. Drew Altman discusses new KFF survey data that shows that a surprising share of older adults with Medicare are using health tech regularly, and a solid majority support many of CMS’ goals to make it more widely available. But there are also big income gaps in the use of health tech, and concerns about AI, privacy, and other barriers to rapid and more widespread adoption. “Apparently… a…