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While Medicare covers a wide range of health care services, Medicare beneficiaries generally pay out-of-pocket for their monthly premiums, deductibles, and cost sharing for Medicare covered services. This brief provides an overview of the costs faced by Medicare beneficiaries in traditional Medicare, Medicare Advantage, and Medicare Part D, including premiums, deductibles, copays, and coinsurance, focusing on costs in 2026.
The U.S. Food and Drug Administration recently approved Opill—the first over-the-counter daily oral contraceptive pill in the United States. Beginning in early 2024, people will be able to purchase Opill without a prescription, expanding options for contraceptive access across the country. On September 15, 2023, a panel of experts joined Laurie Sobel, associate director for KFF’s Women’s Health Policy program, to explore approaches to covering over-the-counter oral contraception without a prescription. The panel discussed lessons…
This policy watch outlines SCOTUS' June 27, 2024, decision dismissing the case, Moyle v. United States, where the Court had been asked to determine if a federal law called the Emergency Medical Treatment and Labor Act preempted Idaho's abortion ban. The decision returns the case to the lower courts and reinstates a court order blocking enforcement of the Idaho ban where it prohibits abortion care for pregnant people having medical emergencies.
This policy brief highlights areas in which HHS, FDA, and CDC have authority to shape U.S. vaccine policy with a specific focus on vaccine approvals and recommendations for the public. Ultimately, while there are limits, federal officials have significant authority to influence and alter vaccine policy, which could affect vaccine availability, views about vaccines, and vaccine use in the U.S. However, this does not include imposing mandates on or changing local vaccination requirements, as those…
This analysis of 2021 claims data finds that while telehealth use remained high in the second year of the COVID-19 pandemic, the shift toward virtual physician and mental health care did not materially affect how much insurers paid for each patient encounter.
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.
Medicaid enrollment increased since the start of the pandemic, primarily due to the continuous enrollment provision.KFF estimates that between 8 million and 24 million people will lose Medicaid coverage during the unwinding of the continuous enrollment provision.The Medicaid continuous enrollment provision stopped “churn” among Medicaid enrollees.States approaches to unwinding the continuous enrollment provision vary.Maximizing streamlined renewal processes can promote continuity of coverage as states unwind the continuous enrollment provision.States have obtained temporary waivers to pursue…
Health care's AI future is being built right now. The open question is “for whom?” Dr. Uché Blackstock — emergency physician, former associate professor at NYU School of Medicine, founder and CEO of Advancing Health Equity, and author of The New York Times bestseller “Legacy: A Black Physician Reckons with Racism in Medicine” — joins host Chip Kahn to argue that AI governance should be shaped not only by regulators and review boards, but by…
In response to long-standing workforce challenges in home- and community-based services, states have reported increasing Medicaid payment rates, providing more education and training or leveraging other strategies to recruit and retain workers.
This brief describes gaps in data about hospital and health system finances and business practices that limit transparency for policymakers, researchers, and consumers. It examines data issues involving finances, debt collection practices, charity care, prices, ownership, and the 340B Drug Pricing Program.
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