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  • Potential Savings for Medicare Part D Enrollees Under Proposals to Add a Hard Cap on Out-of-Pocket Spending

    Issue Brief

    Medicare Part D, the outpatient prescription drug benefit for Medicare beneficiaries, provides coverage above a catastrophic threshold for high out-of-pocket drug costs, but there is no cap on total out-of-pocket drug costs that beneficiaries pay each year. Recent legislative proposals would add a cap on out-of-pocket spending under Part D. This analysis focuses on the potential impact of different out-of-pocket spending caps in terms of how many beneficiaries would be affected and how much they…

  • Medicaid Coverage of Family Planning Benefits: Findings from a 2021 State Survey

    Report

    This report presents survey findings from 41 states and DC about coverage policies for fee-for-service Medicaid in place as of July 1, 2021, for the following categories of family planning benefits: prescription contraceptives, over-the-counter methods, STI & HIV services, well woman care, breast & cervical cancer services, and managed care services

  • 3 Charts: The Cost and Coverage of Opill—the First FDA-approved Over-the-Counter Daily Oral Contraceptive Pill in the United States 

    News Release

    The first FDA-approved over-the-counter daily oral contraceptive pill in the United States— Perrigo’s Opill— is now available for pre-order at major online retailers and will soon be available in stores. Although the new over-the-counter pill could broaden access to contraceptive options in the United States, KFF research suggests consumers are likely to face some hurdles if they seek to have their plan cover the costs. For example, while federal policy requires most private health insurance…

  • Medicare Advantage 2022 Spotlight: First Look

    Issue Brief

    For 2022, the average Medicare beneficiary has access to 39 Medicare Advantage plans, the largest number of options available in the last decade, and can choose from plans offered by nine firms. Among the majority of Medicare Advantage plans that cover prescription drugs, 59 percent will charge no premium in addition to the monthly Medicare Part B premium. As in previous years, the vast majority of Medicare Advantage plans will offer supplemental fitness, dental, vision,…

  • Medicaid Managed Care Plans Can Help Enrollees Maintain Coverage as the Public Health Emergency Unwinds

    Issue Brief

    Throughout the pandemic, states have worked with managed care plans to respond to changing public health conditions and new developments. After the PHE ends, state Medicaid agencies will need to complete a large number of eligibility and enrollment tasks and actions, including processing renewals, redeterminations (based on changes in circumstance), and post-enrollment verifications. Medicaid managed care plans can assist state Medicaid agencies in communicating with enrollees, conducting outreach and assistance, and ultimately, in improving coverage…

  • Millions of Medicare Part D Enrollees Have Had Out-of-Pocket Drug Spending Above the Catastrophic Threshold Over Time

    Issue Brief

    Medicare Part D, the outpatient prescription drug benefit for Medicare beneficiaries, provides catastrophic coverage for high out-of-pocket drug costs, but there is no limit on the total amount that beneficiaries have to pay out of pocket each year. Policymakers on both sides of the aisle support proposals to modify the design of the Part D benefit and establish a hard cap on out-of-pocket prescription drug spending by Part D enrollees. This analysis shows the number…

  • Considerations for Covering Over-the-Counter Contraception

    Policy Watch

    In October 2023, the Departments of the Treasury, Labor, and Health and Human Services issued a request for information to gather public input about the potential benefits, costs, and implementation considerations of requiring private health insurance plans to cover OTC preventive services and supplies without a prescription. This policy watch addresses key considerations for the implementation of insurance coverage for non-prescribed OTC contraceptives based on the lessons learned from KFF’s 2023 study of Insurance Coverage…