Benefits - Research and Data from KFF

Medicare Advantage Plans Denied a Larger Share of Prior Authorization Requests in 2022 Than in Prior Years

Aug 8, 2024

News Release

Medicare 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…

In 2024, A Majority of States Offer Medicare Advantage Plans to Their State Retirees, with 13 Offering Medicare Advantage Exclusively

Jul 2, 2024

Issue Brief

This analysis examines the extent to which states are providing health benefits to their Medicare-eligible retirees through Medicare Advantage arrangements. In 2024, a majority of states offer Medicare Advantage plans to their state retirees, with 13 offering Medicare Advantage exclusively.

10 Things to Know About Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs)

Feb 9, 2024

Issue Brief

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

New $2,000 Medicare Part D Cap Could Reduce Out-of-Pocket Drug Costs for Over One Million Beneficiaries Beginning Next Year, Including Tens of Thousands of Beneficiaries in Most States

Feb 8, 2024

News Release

A KFF analysis shows that a new out-of-pocket spending cap in Medicare Part D could translate into savings for well over 1 million beneficiaries when it takes effect next year, including more than 100,000 people each in California, Florida and Texas, based on analyses of drug spending in 2021. The $2,000 cap, part of the Inflation Reduction Act of 2022, will lead to thousands of dollars in savings for Medicare patients who take high-cost drugs…

Millions of People with Medicare Will Benefit from the New Out-of-Pocket Drug Spending Cap Over Time

Feb 8, 2024

Issue Brief

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…

Medicare Advantage 2024 Spotlight: First Look

Nov 15, 2023

Issue Brief

For 2024, the average Medicare beneficiary has access to 43 Medicare Advantage plans and can choose from plans offered by 8 firms. Among the majority of Medicare Advantage plans that cover prescription drugs, 66 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 benefits, including fitness, dental, vision, and hearing benefits.

Amid Unwinding of Pandemic-Era Policies, Medicaid Programs Continue to Focus on Delivery Systems, Benefits, and Reimbursement Rates

Nov 14, 2023

Report

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.

Medicaid Officials Anticipate Sharp Enrollment Declines and Increases in State Spending on Medicaid as Pandemic-Era Policies Continue to Unwind

Nov 14, 2023

News Release

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.Driven by anticipated changes in enrollment, total Medicaid spending growth (federal and state spending combined) is expected to slow in FY 2024…

With Medicare Open Enrollment Underway, Beneficiaries Typically Will Have a Choice of 43 Medicare Advantage Plans for 2024, Consistent with 2023 But More than Double The Number From 2018

Nov 8, 2023

News Release

With open enrollment underway, Medicare beneficiaries have until December 7th to review and select their coverage for 2024. They also have a lot of options to choose from, as two new KFF analyses show. For many beneficiaries, the first decision is whether to enroll in traditional Medicare (often with supplemental coverage and a stand-alone prescription drug plan) or Medicare Advantage, the private plans sponsored by insurance companies that now cover more than half of all…

Medicare Part D in 2024: A First Look at Prescription Drug Plan Availability, Premiums, and Cost Sharing

Nov 8, 2023

Issue Brief

Medicare Part D prescription drug coverage is available for people with Medicare who enroll in private plans, either a stand-alone prescription drug plan (PDP) for people in traditional Medicare, or a Medicare Advantage plan that covers all Medicare benefits, including prescription drugs (MA-PD). This issue brief provides an overview of Part D plan availability and premiums in 2024 and key trends over time.

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