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Since the 1970s, Medicare beneficiaries have had the option to receive their Medicare benefits through private health plans, mainly Health Maintenance Organizations (HMOs), as an alternative to the federally administered traditional Medicare program. The Balanced Budget Act (BBA) of 1997 named Medicare’s managed care program “Medicare+Choice” and the Medicare Modernization Act (MMA) of 2003 renamed it “Medicare Advantage.”  In 2017, the majority of the 57 million people on Medicare are covered by traditional Medicare, with one-third (33%) enrolled in a Medicare Advantage plan. Since 2004, the number of beneficiaries enrolled in private plans has more than tripled from 5.3 million (13%) to 19.0 million in 2017 (33%).

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Profile and Analysis of the 26 Medicare Advantage Regions

This issue brief examines the 26 new Medicare Advantage PPO regions and their implications for beneficiaries. The paper describes the characteristics of the new Medicare Advantage regions and the extent to which Medicare Advantage plans are already available in each region. It highlights the substantial gap between the current availability…

Summary of Final Regulations Implementing the New Medicare Prescription Drug Benefit

This document summarizes the final regulations to implement the new Medicare prescription drug benefit. The regulations were published by the Centers for Medicare and Medicaid Services (CMS) as a final rule in the Jan. 28 Federal Register. It provides an overview that allows interested parties to obtain information about specific…

Summary of the Proposed Rule to Implement the New Medicare Prescription Drug Benefit

In August 2004, the Centers for Medicare and Medicaid Services published a proposed rule to implement the Medicare Prescription Drug Benefit (Title I of the Medicare Modernization Act). Given the high level of interest in the proposed rules for implementing the Medicare drug benefit, the Kaiser Family Foundation commissioned Health…

Prescription Drug Spending Under The MMA: Modeling The Impact On Out-of-Pocket Costs

This report projects the impact of the new Medicare drug benefit on out-of-pocket spending for people who enroll in 2006. The analysis is based on a model developed by the Actuarial Research Corporation for the Kaiser Family Foundation. The model generally conforms to the Congressional Budget Office’s assumptions and projections…

Estimates of Medicare Beneficiaries’ Out-of-Pocket Drug Spending in 2006

This report projects the impact of the new Medicare drug benefit on out-of-pocket spending for people who enroll in 2006. This analysis from November 2004 estimates that 6.9 million beneficiaries are projected to be affected by the coverage gap (the so-called “doughnut hole”) in the standard Part D drug benefit.…

Grievance and Appeals Procedures: An Analysis of the MMA and Proposed Regulations

This 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…

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