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In 2023, 5.2 million dual-eligible individuals were enrolled in a Medicare Advantage plan designed specifically for dual-eligible individuals, known as Dual-Eligible Special Needs Plans (D-SNPs). This brief highlights 10 things to know about D-SNPs, including national and state enrollment trends, plan availability, insurer participation, benefits, and prior authorization rates and denials
Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work and age. While there are limits, states can use Medicaid – which, by design, serves a primarily low-income population with greater social needs – to address social determinants of health. This brief outlines the range of Medicaid authorities and flexibilities that can be used to add benefits and design programs to address the social determinants of health.
This policy watch explains the Medicaid prescription drug rebate cap, examines how many drugs might be impacted, and explores the implications of recent manufacturer responses for Medicaid programs and enrollees.
This brief provides an overview of the financial assistance provided under the ACA for people purchasing coverage on their own through health insurance Marketplaces (also called exchanges).
You should act now to review your coverage options and sign up for new coverage. If your parents get their insurance through an employer that has at least 20 workers, you may be able to continue that coverage (known as COBRA) for up to 3 years, but it will likely be much more expensive than other coverage options. If you are employed, find out if your employer offers health insurance and if you qualify. If…
Section 1115 Medicaid waivers can allow states to test new approaches in Medicaid that differ from what is required by federal law. This page tracks approved and pending waiver provisions (including expansions and restrictions) related to eligibility, benefits, and social determinants of health and other delivery system reforms.
In a new analysis, KFF finds that 3.6 million people with Medicare could be eligible for coverage of Wegovy (semaglutide) now that the Food and Drug Administration has approved the use of the anti-obesity drug to reduce the risk of heart attacks and stroke in certain patients. This change potentially allows access to Wegovy for just over 1 in 4 of the 13.7 million people on Medicare diagnosed with obesity or overweight, based on data…
This brief focuses on consumers’ understanding of health insurance costs and examines existing federal protections that seek to address barriers to understanding the cost of coverage and care, such as price transparency, self-service price estimator tools, and simplifying cost-sharing designs.
Amid the Trump administration’s increased immigration enforcement efforts, one in five immigrants say they personally know someone who has been arrested, detained or deported since January. Four in ten worry they or a family member could face such action. Many immigrants, including naturalized citizens and those who are lawfully present, say they feel less safe, are avoiding activities outside their home, and no longer view the U.S. as a good destination for immigrants.
Many physicians fear criminalization if state authorities challenge whether their patients qualify under the narrow and vague exceptions in state bans.
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