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This brief examines how leading federal and state policy options related to changes in Medicaid Drug Rebate Program (MDRP), drug pricing, and payment and management of the Medicaid prescription drug would affect state and federal governments as well as private industry (including drug manufacturers, managed care organizations, and pharmacies).
In 2025, Medicare beneficiaries will pay no more than $2,000 out of pocket for prescription drugs covered under Part D, Medicare’s outpatient drug benefit, due to a provision in the Inflation Reduction Act of 2022. This analysis examines how many Medicare Part D enrollees spent $2,000 or more out of pocket in 2021 and over multiple years, both nationally and at the state level, to show how many people over time could benefit from the new Part D spending cap.
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
The 23rd annual survey of state Medicaid directors finds that states expect national Medicaid enrollment will decline by 8.6% in state fiscal year (FY) 2024 as state Medicaid agencies continue to unwind pandemic-related continuous enrollment protections. After reaching record high enrollment, these estimates reflect a dramatic year-over-year decline in program enrollment from that high.
This report highlights certain policies in place in state Medicaid programs in FY 2023 and policy changes implemented or planned for FY 2024, which began on July 1, 2023 for most states.
The Trump administration is proposing a reorganization and staffing cuts at HHS that create uncertainty about the potential effects on older adults, who receive services authorized under the Older Americans Act. This brief provides an overview of programs and services provided under the Older Americans Act, the role played by the Administration for Community Living in administering these programs, and trends in program funding and service utilization by older adults.
This brief considers how default enrollment into Medicare Advantage might work, potential challenges with this approach, and implications for beneficiaries, insurers, providers, agents and brokers, and the federal budget.
Medicare provides significant health and financial protections to more than 60 million Americans, but there are gaps in coverage and high cost-sharing requirements that can make health care difficult to afford. This report analyzes several policy options that could help make health care more affordable for people covered by Medicare, especially beneficiaries with relatively low incomes: adding an out-of-pocket limit to traditional Medicare, adding a hard out-of-pocket cap to Part D, expanding financial assistance through the Medicare Savings Programs, and expanding financial assistance through the Part D low-income subsidy program.
In Medicare Physician Fee Schedule Final Rules from recent years, the administration made changes to Medicare payment policies for certain dental services, in addition to other payment and policy changes. The 2023 rule clarified CMS’s interpretation of when medically necessary dental services can be covered and codified certain payment policies, and the 2023, 2024, and 2025 rules define new clinical scenarios for which Medicare payment can be made for dental services. This brief describes current law related to coverage and payment for dental services under Medicare and the rationale for changes to current policy, explains changes to dental payment and coverage included in these rules, and discusses the impact on Medicare and beneficiaries. While these changes are projected to benefit a small number of Medicare beneficiaries, they do not represent a broad expansion of Medicare coverage of dental services.
The Medicare Part D program provides an outpatient prescription drug benefit to older adults and people with long-term disabilities in Medicare who enroll in private plans. This brief analyzes Medicare Part D enrollment and costs in 2023 and trends over time. The analysis highlights the substantial growth of Medicare Advantage drug plans in the marketplace for Part D drug coverage, where enrollment overall is concentrated in a handful of large plan sponsors.
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