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Medicaid 1115 Waiver Watch: Round-up of Key Themes at the End of the Biden Administration
Issue BriefSection 1115 Medicaid demonstration waivers offer states an avenue to test new approaches in Medicaid that differ from what is required by federal statute, so long as the approach is likely to “promote the objectives of the Medicaid program.” Waivers generally reflect priorities identified by states as well as changing priorities from one presidential administration to another. The Biden administration encouraged states to propose waivers that expand coverage, reduce health disparities, advance whole-person care, and…
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A Current Snapshot of the Medicare Part D Prescription Drug Benefit
Issue BriefThis brief provides an overview of the Medicare Part D prescription drug benefit, including current data on plan availability, enrollment, and spending and financing, and highlights changes made under the Inflation Reduction Act.
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Medicare Advantage Plans Denied a Larger Share of Prior Authorization Requests in 2022 Than in Prior Years
News ReleaseMedicare Advantage plans denied 3.4 million prior authorization requests for health care services in whole or in part in 2022, or 7.4% of the 46.2 million requests submitted on behalf of enrollees that year, according to a new KFF analysis of federal data. That was a higher share of denials than in recent years. The share of all prior authorization requests denied by Medicare Advantage plans increased from 5.7% in 2019, 5.6% in 2020 and…
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Key Facts About Medicare Part D Enrollment, Premiums, and Cost Sharing in 2025
Issue BriefThe Medicare Part D program provides an outpatient prescription drug benefit to more than 50 million older adults and people with long-term disabilities in Medicare who enroll in private plans, including stand-alone prescription drug plans (PDPs) to supplement traditional Medicare and Medicare Advantage prescription drug plans (MA-PDs) that include drug coverage and other Medicare-covered benefits. This brief analyzes Medicare Part D enrollment and costs in 2025 and trends over time, based on data from the…
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Modifying Traditional Medicare’s Benefit Design Could Reduce Federal Spending But With Cost Tradeoffs Between Beneficiaries and The Federal Government
News ReleaseRevamping traditional Medicare’s benefit design and restricting “first-dollar” supplemental coverage could reduce federal spending, simplify cost sharing, protect against high medical costs, decrease out-of-pocket spending for many beneficiaries, and provide more help to those with low incomes -- but would be unlikely to achieve all of these goals simultaneously.
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Medicare’s Drug Benefit Is Firmly-Established After Its First Decade, With Flat Premiums in Recent Years but Higher Cost-Sharing Over Time
News ReleaseWith Medicare Part D nearing the end of its tenth year, the program -- which now provides drug coverage to 72 percent of all Medicare beneficiaries -- has experienced no growth in average premiums in recent years but some notable increases in cost-sharing, according to a new report from the Kaiser Family Foundation. At a time of heightened public concern about the cost of prescription drugs, the report, Medicare Part D at Ten Years: The…