Medicare Program Integrity and Efforts to Root Out Improper Payments, Fraud, Waste and Abuse
This brief explains fraud, waste, abuse, and improper payments in Medicare and describes actions to ensure Medicare program integrity.
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Most People in the Most Rural Counties Get Medicare Coverage from Traditional Medicare
Issue BriefWhile enrollment in Medicare Advantage, the private plan alternative to traditional Medicare, has grown steadily over the past decade, traditional Medicare remains the most common source of coverage for people who live in rural areas.
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Medicare Payments and Beneficiary Costs for Prescription Drug Coverage
Issue BriefThis March 2007 issue brief, commissioned by the Kaiser Family Foundation, provides a basic introduction to the reimbursement system for private Medicare drug plans. It explains the system of plan bidding and payment, including the special provisions for low-income enrollees, and considers how aspects of the payment system may affect the total cost of the drug benefit over time, the cost of coverage for beneficiaries and the variety and quality of available plans. Mark Merlis…
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Is Medicare’s New Provider Search Tool a Step in the Right Direction?
Quick TakeThe new provider search tool on the Medicare Plan Finder could make it easier for beneficiaries to figure out if their doctors are in a Medicare Advantage plan's network despite some data issues.
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Grievance and Appeals Procedures: An Analysis of the MMA and Proposed Regulations
Issue BriefThis paper, by Sara Rosenbaum, J.D., Director of the Center for Health Services Research and Policy at George Washington University, examines the procedures for resolving beneficiaries' grievances and appeals under the new Medicare drug benefit. It is one in a series commissioned by the Kaiser Family Foundation that analyzes issues surrounding the implementation of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and the proposed regulations. Issue Brief (.pdf)
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Medicare Advantage Insurers Often Use Rewards and Incentives to Encourage Enrollees to Complete Health Risk Assessments (HRAs)
Issue BriefThis analysis examines the share of Medicare Advantage enrollees in contracts (which usually include multiple plans) that offered rewards or incentives for completing health risk assessments (HRAs) in 2023, as well as differences across Medicare Advantage insurers.
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Total Medicare Private Health Plan Enrollment, Current and Projected
FeatureTotal Medicare Private Health Plan Enrollment, 1992-2026 Download Source Congressional Budget Office's March 2016 Medicare Baseline, CMS Medicare Advantage enrollment files for 2008-2014, and MPR's "Tracking Medicare Health and Prescription Drug Plans Monthly Report" for 1992-2007.
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Some Counties May Lack an ACA Marketplace Insurer Next Year – But Many More Lack Medicare Advantage Plans Today
Issue BriefThis issue brief notes that more counties lack Medicare Advantage plans than are at risk of not having an Affordable Care Act marketplace insurer next year. It examines the overlap between the counties without Medicare Advantage or marketplace insurers and assesses some of the potential reasons why such counties have trouble attracting insurers.
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Issues for Medicare Beneficiaries in Long-Term Care Facilities: An Analysis of the MMA and Proposed Regulations
Issue BriefThis paper, by Vicki Gottlich, J.D., of the Center for Medicare Advocacy, looks at issues related to the new Medicare prescription drug benefit for people with Medicare who live in nursing homes or other long-term-care settings. It is one in a series commissioned by the Kaiser Family Foundation that analyzes issues surrounding the implementation of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and the proposed regulations. Issue Brief (.pdf)
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Analysis Suggests Health Insurers Remained Profitable Across Markets Amid Pandemic in 2020
News ReleaseA new analysis of health insurers’ financial data suggests that they remained profitable across markets in 2020 due in part to an unprecedented decrease in health spending and utilization in the spring as the COVID-19 pandemic led to massive shutdowns.