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

    Issue Brief

    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 Policy Alternatives, Inc. to prepare this summary of the proposed regulations. Issue Brief (.pdf)

  • Amid Merger Talk, a Look at Health Insurers’ Medicare Business

    News Release

    With recent news about possible health insurance company mergers, Drew Altman looks beyond the impact on Wall Street to how mergers could affect Medicare beneficiaries in his latest column for The Wall Street Journal's Think Tank. All previous columns by Drew Altman are available.

  • Visualizing Health Policy: The Role of Medicare Advantage

    Other Post

    This September 2014 Visualizing Health Policy Infographic examines the role of private plans, such as HMOs and PPOs, in Medicare. These Medicare Advantage plans offer an alternative to traditional Medicare and provide all benefits covered under Medicare Parts A and B, and often Part D. The infographic includes data on Medicare Advantage penetration across the country. It shows the concentration of enrollment among a small number of firms and affiliates, and displays the extent to…

  • What’s In and What’s Out? Medicare Advantage Market Entries and Exits for 2015

    Issue Brief

    This Data Note examines the availability of plans nationwide and by state in 2015, and changes in plan availability since 2011. It documents the number and share of Medicare Advantage enrollees affected by plan withdrawals each year, the characteristics of plans that will be entering the market and characteristics of those exiting the market in 2015.

  • Medicare Advantage Payments to Increase Again

    Quick Insights

    The increase translates into an additional $35 billion to Medicare Advantage plans in 2026 compared to this year….The increase in payments is larger than for 2025 (3.7%) or 2024 (3.3%), but below the increase for 2023 (8.5%), and comes at a time of increasing scrutiny over Medicare Advantage payments.

  • Medicare Advantage Plans Denied 2 Million Prior Authorization Requests in 2021, About 6% of Such Requests

    News Release

    Medicare Advantage plans denied two million prior authorization requests for health care services in whole or in part in 2021, or about six percent of the 35 million requests submitted on behalf of enrollees that year, a new KFF analysis finds. Prior authorization is intended to ensure that health care services are medically necessary by requiring providers to obtain approval before a service or other benefit is covered. While prior authorization has long been used…

  • A Review of 62 Studies Finds Few Big Differences Between Traditional Medicare and Medicare Advantage on a Variety of Measures

    News Release

    With the Medicare open enrollment period set to begin Oct. 15, a perennial decision faced by Medicare beneficiaries is whether to get their coverage through traditional Medicare or the private plans known as Medicare Advantage. A new KFF review of 62 studies published since 2016 that compares Medicare Advantage and traditional Medicare on measures of beneficiary experience, affordability, utilization, and quality finds few differences that are supported by strong evidence or have been replicated across…