This analysis examines how often patients get hit with surprise medical bills, what circumstances tend to give rise to them and what proposals are being considered to protect consumers from this problem.
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Medicare Part D has helped to make prescription drugs more affordable for people with Medicare, yet many beneficiaries continue to face high out-of-pocket costs for their medications. Specialty tier drugs are a particular concern for Part D enrollees in this context. This analysis draws on data from Medicare’s Plan Finder website to calculate expected annual 2019 out-of-pocket costs for 30 specialty tier drugs used to treat four health conditions—cancer, hepatitis C, multiple sclerosis, and rheumatoid arthritis.
In 2020, more than 22 million Medicare beneficiaries (34%) are enrolled in Medicare Advantage plans, which are mainly HMOs and PPOs offered by private insurers as an alternative to the traditional Medicare program. This data note provides an overview of the Medicare Advantage plans that will be available in 2020, including the variation in the number of plans available by county and plan type. The brief also examines the insurers entering the Medicare Advantage market for the first time and also examines the insurers exiting the market.
Medicare Beneficiaries Without Supplemental Coverage Are at Risk for Out-of-Pocket Costs Relating to COVID-19 Treatment
Most Medicare Advantage enrollees are in plans that have waived cost sharing for COVID-19 treatment, and many other beneficiaries in traditional Medicare have their cost sharing covered by supplemental insurance. This blog post discusses the 6 million Medicare beneficiaries without supplemental coverage who would face out-of-pocket costs if they require treatment for COVID-19.
Few issues are likely to matter as much to voters in November’s presidential election as President Trump’s response to the COVID-19 pandemic and resulting economic crisis, which have left almost 200,000 Americans dead and prompted job layoffs and furloughs affecting tens of millions of Americans. A new election brief compares…
A Status Report on Prescription Drug Policies and Proposals at the Start of the Biden Administration
This brief provides a status update on prescription drug final rules advanced by the Trump Administration in its final months related to Medicare, importation, and 340B pricing for insulin and epinephrine, and an overview of key drug pricing proposals related to Medicare and prescription drug prices generally that were voted on but not enacted in the previous Congress that may return to the forefront of health policy discussions in the coming years.
For 2022, the average Medicare beneficiary has access to 39 Medicare Advantage plans, the largest number of options available in the last decade, and can choose from plans offered by nine firms. Among the majority of Medicare Advantage plans that cover prescription drugs, 59 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 fitness, dental, vision, and hearing benefits. In addition, virtually all will also offer telehealth benefits in 2022.
This issue brief provides an overview of the Medicare Part D prescription drug benefit market for 2022, with a primary focus on stand-alone drug plans. It includes national and state-level data on plan availability, premiums, benefit design, cost sharing, information about premium-free plans for low-income beneficiaries, and information about the national Part D drug plans available in 2022.
This data note explores findings from on an 8-day online search for at home COVID-19 tests at major retailers. The findings are described against the backdrop of the Biden Administration policy requiring plans to cover the cost of these tests. We find that these tests remain hard to find and that this limited availability could negatively affect the success of the reimbursement strategy.
This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs, and employer practices. Annual premiums for employer-sponsored family health coverage reached $21,342 this year, up 4% from last year, with workers on average paying $5,588 toward the cost of their coverage.