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  • Medicaid: What to Watch in 2020

    Issue Brief

    Medicaid, the provider of health insurance coverage for about one in five Americans and the largest payer for long-term care services in the community and nursing homes, continues to be a key part of health policy debates at the federal and state level. Key Medicaid issues to watch in 2020 include: Medicaid expansion developments; Section 1115 waiver activity; enrollment and spending trends; benefits, payment and delivery system reforms, and the implications of the 2020 elections.

  • Why it Matters: Tennessee’s Medicaid Block Grant Waiver Proposal

    Issue Brief

    On November 20, 2019, Tennessee submitted an amendment to its longstanding Section 1115 Waiver that would make major financing and administrative changes to its Medicaid program. The Centers for Medicare and Medicaid Services (CMS) certified the waiver as complete and opened a federal public comment period through December 27, 2019. Most significantly, Tennessee is requesting to receive federal funds in the form of a “modified block grant” and to retain half of any federal “savings”…

  • Medicare Beneficiaries Spent an Average of $5,460 Out-of-Pocket for Health Care in 2016, With Some Groups Spending Substantially More 

    News Release

    The average person with traditional Medicare coverage paid $5,460 out of their own pocket for health care in 2016, according to a new KFF analysis and interactive tool. This $5,460 includes about $1,000 in out-of-pocket spending for long-term care facility services, averaged across all traditional Medicare beneficiaries.  Such services are used by only 5 percent of beneficiaries in traditional Medicare. For the 95 percent of beneficiaries living in the community, average out-of-pocket spending on health…

  • How Much Do Medicare Beneficiaries Spend Out of Pocket on Health Care?

    Issue Brief

    This analysis presents the most current data on out-of-pocket health care spending by Medicare beneficiaries, both overall and among different groups of beneficiaries. The analysis explores how much Medicare beneficiaries spend out of pocket in total on health care premiums and health-related services, on average; how much beneficiaries spend out of pocket on different types of health-related services; and what share of income beneficiaries spend on out-of-pocket health care costs.

  • Medicare Part D Beneficiaries Who Reach the Catastrophic Coverage Limit Can Expect to Pay More Out-of-Pocket for Their Prescription Drugs Next Year

    News Release

    Medicare Part D enrollees with relatively high out-of-pocket expenses can expect see their costs rise in 2020, according to a new KFF analysis. This is mainly due to an increase in how much enrollees will pay out of pocket for their prescription drugs in the Part D benefit coverage gap phase before they qualify for catastrophic coverage. The analysis finds that out-of-pocket drug costs will increase by nearly $400 -- from $2,275 in 2019 to…

  • Financial Performance of Medicare Advantage, Individual, and Group Health Insurance Markets

    Issue Brief

    Three key private health insurance markets -- Medicare Advantage, the individual market and the fully-insured group market -- appear to be financially healthy and attractive to insurers. The private Medicare Advantage market generates significantly larger gross margins per person than the individual market or fully-insured market. The future of these markets has become a focus for policymakers amid the debate over Medicare for All.

  • What Percent of New Medicare Beneficiaries Are Enrolling in Medicare Advantage?

    Issue Brief

    The analysis examines enrollment in Medicare Advantage plans during beneficiaries’ first year on Medicare and finds that less than one-third or 29% enrolled in these private health plans, including HMOs or PPOs. The majority of people new to Medicare are choosing traditional Medicare in the year they first go on Medicare. The study looks at how these findings vary across age, Medicaid status, states, and counties.