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This paper, by Joy Pritts of the Health Policy Institute at Georgetown University, looks at issues related to drug plan marketing activities and privacy under the MMA. Issue Brief (.
As Medicare Advantage continues to grow, a gradual but significant reshaping of the Medicare program is taking place. A new KFF analysis finds that nearly half of eligible Medicare beneficiaries – 28.4 million out of 58.6 million Medicare beneficiaries overall – are now enrolled in Medicare Advantage plans.
As Medicare’s annual open enrollment period gets underway, two new analyses from KFF suggest that a relatively small share of the nation’s 65 million Medicare beneficiaries will shop around among the many coverage options for 2023 or switch plans. That decision could have a significant impact on enrollees’ coverage and costs.
The private plans known as Medicare Advantage now cover more than 4 in 10 Medicare beneficiaries, reflecting a more than doubling of enrollment over the past decade even as the plans remain a far larger presence in some states than others, according to a new KFF analysis.
Among people with Medicare, Black beneficiaries are more likely to have cost-related problems with their health care than White beneficiaries, finds a new KFF analysis, with the racial disparity persisting among beneficiaries in both traditional Medicare and Medicare Advantage plans.
These FAQs provide the latest guidance on testing and treatment related to COVID-19 for Medicare beneficiaries, including questions related to out-of-pocket costs, the COVID-19 vaccine, telehealth, extended supplies of medication, skilled nursing facility stays, and issues for people in private Medicare Advantage plans.
As the coronavirus continues to spread, the number of people on Medicare admitted to the hospital for COVID-19 related illness is expected to rise. We analyze how much Medicare beneficiaries could pay out-of-pocket for an inpatient hospital admission under traditional Medicare (assuming no supplemental coverage) or Medicare Advantage plans.
The Biden Administration's requirement for private insurers to cover the cost of at-home rapid COVID-19 tests for their enrollees does not apply to Medicare. Medicare Advantage plans (offered by private insurers) have the option to cover at-home tests but are not required to do so. This policy watch examines whether some of the largest private Medicare Advantage plans are covering the cost of at-home rapid tests for COVID-19.
Medicare Advantage enrollees are encouraged to select their plan based on a number of factors, including premiums, cost-sharing, extra benefits, drug coverage, quality of care, and provider networks, but a potentially overlooked factor is access to covered services and the potential impact of prior authorization requirements. In this data note, we examine the share of Medicare Advantage enrollees that are in plans requiring prior authorization and approval before covering the costs of services.
The analysis finds that people who switched from traditional Medicare to Medicare Advantage in 2016 had health spending in 2015 that was $1,253 less, on average, than the average spending for beneficiaries who remained in traditional Medicare (after adjusting for health risk). The findings suggest that the current payment method may systematically overestimate expected costs of Medicare Advantage enrollees. Adjusting payments to reflect Medicare Advantage enrollees’ prior use of health services could potentially lower total Medicare spending by billions of dollars over a decade.
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