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Medicare Part D: A First Look at Prescription Drug Plans in 2018

This issue brief provides an overview of the 2018 Medicare Part D stand-alone prescription drug plan landscape, the largest segment of the Part D marketplace, 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 top ten Part D plans in 2018.

Preventive Services Covered by Private Health Plans under the Affordable Care Act

This fact sheet, Preventive Services Covered by Private Health Plans under the Affordable Care Act (ACA), examines the types of preventive services or benefits that must be covered without cost sharing for adults and children. The fact sheet explores the rules and challenges of implementing coverage, as well as the application of reasonable medical management, and it outlines steps the government has taken to address these issues.

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

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…

Premiums and Cost-Sharing in Medicaid

Medicaid, the nation’s public health insurance program for low-income people, now covers nearly 60 million Americans, including many working families, low-income elderly, and individuals with disabilities. Medicaid beneficiaries tend to be poorer and sicker than those enrolled in private insurance. Given these characteristics, federal law limits the extent to which…

Private Insurance Benefits and Cost-Sharing Under the ACA

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…

Betting on Private Insurers

Just-released estimates of national health spending in 2010 by the Centers for Medicare and Medicaid Services (CMS) show that 45% of our health care spending is financed by the federal and state governments, primarily through the Medicare and Medicaid programs. This share has grown temporarily in recent years because of the…

2012 Employer Health Benefits Survey

This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, and other relevant information. The survey continues to document employer’s implementation of health reform with question on the percent of firms with grandfathered health plans and enrollment of adult children due to the new health reform law. The 2012 survey included 3,326 randomly selected public and private firms with three or more employees (2,121 of which responded to the full survey and 1,205 of which responded to an additional question about offering coverage).

Managing Medicaid Pharmacy Benefits: Current Issues and Options

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…

What the Actuarial Values in the Affordable Care Act Mean

The Patient Protection and Affordable Care Act (PPACA) establishes four levels of coverage based on the concept of “actuarial value,” which represents the share of health care expenses the plan covers for a typical group of enrollees. As plans increase in actuarial value – bronze, silver, gold, and platinum –…

Performing Under Pressure: Annual Findings of a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2011-2012

The annual 50-state survey of Medicaid and CHIP eligibility rules, enrollment and renewal procedures and cost-sharing practices, conducted by the Kaiser Commission on Medicaid and the Uninsured with the Georgetown University Center for Children and Families, found that, despite continued fiscal pressures on states, eligibility policies remained stable in nearly…

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.