Medicare Payments and Beneficiary Costs for Prescription Drug Coverage
This March 2007 issue brief, commissioned by the Kaiser Family Foundation, provides a basic introduction to the reimbursement system for private Medicare drug plans.
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Summary of the Proposed Rule to Implement the New Medicare Prescription Drug Benefit
Issue BriefIn 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).
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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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Issue Briefs Describe Changes in Private Plan Market and Effects on Medicare Beneficiaries
Issue BriefThese two issue briefs describe the different types of private plan options available to people on Medicare, identify key characteristics of the organizations offering the new Medicare drug benefit, and analyze how companies are positioning themselves to attract Medicare enrollees.
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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.
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Marketing and Privacy Issues: An Analysis of the MMA and Proposed Regulations
Issue BriefThis 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 (.
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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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Visualizing Health Policy: The Role of Medicare Advantage
Other PostThis 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 which Medicare pays more for Medicare Advantage enrollees than for beneficiaries in fee for service Medicare, on average, and that the payment differential is declining
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What Happens When COVID-19 Emergency Declarations End? Implications for Coverage, Costs, and Access
Issue BriefThis brief provides an overview of the major health-related COVID-19 federal emergency declarations that have been made since early on in the pandemic, summarizes the flexibilities triggered by each, and identifies the implications for their ending, related to coverage, costs, and payment for COVID-19 testing, treatments, and vaccines; Medicaid coverage and federal match rates; telehealth; access to medical countermeasures through FDA emergency use authorization (EUA); and other Medicaid, Medicare and private health insurance flexibilities.
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Medicare Advantage Plan Switching: Exception or Norm?
Issue BriefThe Medicare open enrollment period allows enrollees to compare plans, stick with their current plan, switch to another plan, or shift to traditional Medicare. This analysis examines the extent to which Medicare Advantage enrollees change plans when given the opportunity. It also analyzes the variation in the rate of plan switching by enrollee and plan characteristics and whether people who voluntarily switch plans tend to move to plans with lower premiums, lower out-of-pocket limits, or higher quality ratings.