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  • Problems Getting Care Due to Cost or Paying Medical Bills Among Medicare Beneficiaries

    Issue Brief

    There is ongoing discussion as to whether Congress should waive COVID-19 treatment costs. To inform these discussions, this analysis examines the extent of health care cost-related problems among Medicare beneficiaries. The analysis is based on a composite measure of cost-related burdens that includes problems getting care due to cost, delays seeking care due to cost, and problems paying medical bills among people with Medicare.

  • Medicare Beneficiaries Without Supplemental Coverage Are at Risk for Out-of-Pocket Costs Relating to COVID-19 Treatment

    Policy Watch

    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.

  • KFF Analysis: Number of Coronavirus Cases, Distribution of $30B in CARES Act funding and Medicare Advantage Penetration by State

    Fact Sheet

    Number of Coronavirus Cases, Distribution of $30B in CARES Act funding and Medicare Advantage Penetration by StateStateNumber ofCOVID-19 Cases on April 21, 2020Percent of Total COVID-19 CasesFirst Distribution of CARES Act PaymentsPercent of Total Money DistributedPercent of Medicare Beneficiaries in Medicare Advantage, 2020New York253,400.0032.1%$1,859,574,4346.2%40%New Jersey88,806.0011.3%$919,426,8013.1%29%Massachusetts39,643.005.0%$841,425,1202.8%23%Pennsylvania34,005.004.3%$1,246,250,0764.2%41%California33,866.004.3%$2,920,960,7339.7%40%Michigan32,000.004.1%$936,700,1393.1%42%Illinois31,508.004.0%$1,204,103,1804.0%25%Florida27,058.003.4%$2,220,563,1377.4%43%Louisiana24,523.003.1%$474,891,7351.6%38%Connecticut19,815.002.5%$377,981,2571.3%41%Texas20,087.002.5%$2,089,066,4527.0%37%Georgia19,398.002.5%$792,069,1602.6%37%Maryland14,193.001.8%$742,225,3062.5%11%Ohio12,919.001.6%$989,773,4173.3%39%Washington12,486.001.6%$553,838,8061.8%33%Indiana11,688.001.5%$668,604,6142.2%32%Colorado10,112.001.3%$360,905,4821.2%38%Virginia9,097.001.2%$814,360,4672.7%21%Tennessee7,238.000.9%$739,723,3472.5%38%North Carolina6,979.000.9%$919,171,0873.1%36%Missouri5,963.000.8%$618,601,1672.1%35%Rhode Island5,090.000.6%$90,459,8340.3%39%Arizona5,068.000.6%$707,587,4822.4%39%Alabama5,092.000.6%$449,481,9451.5%41%Mississippi4,512.000.6%$374,847,7901.2%20%Wisconsin4,541.000.6%$471,681,0771.6%42%South Carolina4,439.000.6%$518,022,4631.7%28%Nevada3,830.000.5%$241,471,8410.8%36%Utah3,213.000.4%$185,292,4220.6%36%Iowa3,159.000.4%$297,929,1711.0%22%Kentucky3,050.000.4%$452,761,1711.5%34%District of Columbia3,098.000.4%$84,989,0990.3%20%Delaware2,745.000.3%$154,114,1180.5%17%Oklahoma2,680.000.3%$489,853,9981.6%22%Minnesota2,470.000.3%$472,206,1221.6%43%Kansas2,070.000.3%$325,135,9501.1%19%Oregon1,956.000.2%$291,029,0251.0%42%Arkansas1,990.000.3%$326,536,0431.1%26%New Mexico1,971.000.2%$169,486,1320.6%35%South Dakota1,685.000.2%$107,650,2010.4%19%Idaho1,736.000.2%$135,028,0560.5%33%Nebraska1,648.000.2%$225,027,9120.8%17%New Hampshire1,447.000.2%$164,580,3860.5%19%Puerto Rico1,298.000.2%$41,889,8220.1%70%West Virginia908.000.1%$246,574,8510.8%31%Maine875.000.1%$145,763,8120.5%36%Vermont816.000.1%$54,457,8700.2%12%North Dakota627.000.1%$91,064,5790.3%17%Hawaii584.000.1%$132,536,0760.4%44%Montana433.000.1%$111,503,2480.4%18%Alaska321.000.0%$71,248,1230.2%1%Wyoming429.000.1%$66,393,1630.2%3%NOTES: COVID-19 data as of 4/21/2020 at 10:38 AM.SOURCES: Johns Hopkins University, [Coronavirus COVID-19 Global Cases by the Center for…

  • New OIG Report Examines Prior Authorization Denials in Medicaid MCOs

    Policy Watch

    Congress asked the U.S Department of Health and Human Services (HHS) Office of the Inspector General (OIG) to investigate whether Medicaid MCOs are providing medically necessary health care services to their enrollees. OIG found that Medicaid MCOs had an overall prior authorization denial rate of 12.5%–more than 2 times higher than the Medicare Advantage rate. Prior authorization denial rates ranged widely across and within parent firms and states. After a prior authorization request is denied,…

  • Medicare Advantage Insurers Will Collect at Least $12.8 Billion in Federal Bonus Payments in 2023—a Nearly 30% Increase from 2022

    News Release

    Federal spending on bonus payments to insurance companies that offer Medicare Advantage plans will reach at least $12.8 billion in 2023, according to a new KFF analysis. That is a nearly 30% increase from 2022, and more than quadruple the spending in 2015. These data come from one of three analyses released today by KFF that examine various facets of the Medicare Advantage program, which provides health insurance coverage to nearly 31 million Americans. KFF…

  • How Health Insurers and Brokers Are Marketing Medicare

    Report

    To capture the state of television marketing activities and consider the implications for people with Medicare, KFF analyzed ad data compiled by the Wesleyan Media Project, that were obtained from Vivvix (formerly Kantar) CMAG, a data analytics and consulting firm, and were coded by the Wesleyan Media Project in collaboration with KFF. The data set included all English-language TV ads that aired across national and local markets on broadcast television or national cable, from October…

  • Mental Health and Substance Use Disorder Coverage in Medicare Advantage Plans

    Issue Brief

    This brief describes the scope of mental health and substance use disorder benefits in Medicare Advantage plans, including extra benefits, cost sharing, and prior authorization and referral requirements, based on an analysis of the Centers for Medicare and Medicaid Services (CMS) Medicare Advantage plan benefit and enrollment files for 2022.

  • Medicare Beneficiaries Rarely Change Their Coverage During Open Enrollment

    Issue Brief

    During the Medicare open enrollment period for 2020, Medicare beneficiaries had an average of 24 Medicare Advantage prescription drug plans and 28 stand-alone Part D prescription drug plans to choose from for their coverage. Despite having so many Medicare options, relatively few Medicare private plan enrollees opted to switch their coverage.

  • Extra Benefits Offered by Medicare Advantage Firms Vary

    Issue Brief

    Nearly all enrollees in Medicare Advantage plans sponsored by the seven largest firms in the market are in a plan that offers some vision, hearing, fitness, and/or dental benefits. Other benefits, including over the counter, remote access technologies, meals, acupuncture and transportation, vary widely across firms, and in-home support services, bathroom safety, Part B rebates, telemonitoring and caregiver support are relatively uncommon