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  • Medicare Part D 2010 Data Spotlight: Benefit Design and Cost Sharing

    Report

    The Medicare Modernization Act established a defined standard drug benefit for Part D stand-alone Prescription Drug Plans (PDPs) and Medicare Advantage Prescription Drug (MA-PD) plans, while giving plans flexibility to offer alternative benefit designs. Only about one in 10 PDPs offer the standard benefit in 2010. Plan sponsors can offer alternative benefit designs that are, at a minimum, actuarially equivalent to the defined standard and can also offer enhanced benefits. This Medicare Part D data…

  • Essential Health Benefits: Balancing Affordability and Adequacy

    Event Date:
    Event

    Under the Patient Protection and Affordable Care Act (PPACA), insurance plans offered through state insurance exchanges as well as non-grandfathered plans offered in the individual and small group markets - will be required to cover a set of health benefits and services called the "essential health benefits" package. Guidance issued last month by the Department of Health and Human Services will give each state some discretion to specify benefits package raises many questions. What is…

  • Medicaid: A Primer – Key Information on the Nation’s Health Coverage Program for Low-Income People

    Issue Brief

    This Medicaid primer provides an overview of the nation's largest health coverage program, which covers more than 62 million low-income individuals, including children and families, people with disabilities and seniors who are also covered by Medicare. Medicaid also is the dominant source of the country’s long-term care financing. The program will expand significantly under the Affordable Care Act in 2014.

  • Coverage of Low-Income Adults by Scope of Coverage, January 2013

    Feature

    Coverage of Low-Income Adults by Scope of Coverage, January 2013 Download Source Based on the results of a national survey conducted by the Kaiser Commission on Medicaid and the Uninsured and the Georgetown University Center for Children and Families, 2013  

  • Managing Medicaid Pharmacy Benefits: Current Issues and Options

    Report

    This report examines reimbursement, benefit management and cost sharing issues in Medicaid pharmacy programs. The analysis, conducted by researchers from the Foundation's Kaiser Commission on Medicaid and the Uninsured and Health Management Associates, focuses on the potential of several measures recently highlighted by Health and Human Services Secretary Kathleen Sebelius to reduce Medicaid pharmacy costs and is informed, in part, by the perspectives of a group of Medicaid pharmacy administrators convened by the Foundation in…

  • Private Insurance Benefits and Cost-Sharing Under the ACA

    Perspective

    The Department of Health and Human Services (HHS) recently released guidance on the two key components that determine the level of protection that private insurance plans will provide to consumers under health reform. The first involves the services that insurance plans must cover, and the second involves how much patients must pay out-of-pocket for those services. The Affordable Care Act (ACA) establishes new rules for what insurers must provide for both components starting in 2014.…

  • The Future of Medicare Advantage: Are We on the Right Path?

    Event Date:
    Event

    This June 10 briefing looked at Medicare Advantage and changes affecting it, including revised calculations of payments from CMS, and the Affordable Care Act's reduced payments to Medicare Advantage plans. Speakers discussed how Medicare Advantage plans are expected to respond to payment changes; if quality bonus payments created significant changes in patient care or plan choices; and what implications could these decisions have on beneficiaries with regard to premiums, benefits and more.

  • What is a Mini-Med Plan?

    Perspective

    One of the early insurance market changes in the Affordable Care Act (ACA) phases out caps that some insurance plans impose on the annual dollar amount of benefits they will cover. Plans issued or renewed after September 23, 2010 cannot have annual limits of less than $750,000, and the threshold goes up to $1.25 million in 2011. Annual dollar limits of any kind are prohibited starting in 2014. The federal government has issued waivers from…

  • Medicaid Expansion through Premium Assistance: Key Issues for Beneficiaries in Arkansas’ Section 1115 Demonstration Waiver Proposal

    Issue Brief

    This issue brief provides background about Medicaid premium assistance in the individual health insurance market, summarizes major components of Arkansas’ Section 1115 demonstration waiver application to implement the Affordable Care Act’s Medicaid expansion through premium assistance, and considers key issues affecting beneficiaries.