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  • Medicare Advantage 2023 Spotlight: First Look

    Issue Brief

    For 2023, the average Medicare beneficiary has access to 43 Medicare Advantage plans and can choose from plans offered by nine firms. Among the majority of Medicare Advantage plans that cover prescription drugs, 66 percent will charge no premium in addition to the monthly Medicare Part B premium. As in previous years, the vast majority of Medicare Advantage plans will offer supplemental benefits, including fitness, dental, vision, and hearing benefits. In addition, virtually all will…

  • Half of All Eligible Medicare Beneficiaries Are Now Enrolled in Private Medicare Advantage Plans

    Policy Watch

    Recently released data show that Medicare Advantage, the private plan alternative to traditional Medicare, now covers half of eligible Medicare beneficiaries. As the role of Medicare Advantage grows, so will interest in understanding how well the program serves the increasingly diverse group of enrollees who receive their Medicare coverage from private insurers.

  • FAQs on Medicare Coverage and Costs Related to COVID-19 Testing and Treatment

    Issue Brief

    These FAQs provide the latest guidance on testing and treatment related to COVID-19 for Medicare beneficiaries, including questions related to out-of-pocket costs, the COVID-19 vaccine, telehealth, extended supplies of medication, skilled nursing facility stays, and issues for people in private Medicare Advantage plans.

  • Prior Authorization in Medicare Advantage Plans: How Often Is It Used?

    Issue Brief

    Medicare Advantage enrollees are encouraged to select their plan based on a number of factors, including premiums, cost-sharing, extra benefits, drug coverage, quality of care, and provider networks, but a potentially overlooked factor is access to covered services and the potential impact of prior authorization requirements. In this data note, we examine the share of Medicare Advantage enrollees that are in plans requiring prior authorization and approval before covering the costs of services.

  • Three firms Account for Over Half of All Medicare Part D Enrollees in 2018, and Pending Mergers Would Further Consolidate the Marketplace

    News Release

    In 2018, three Medicare Part D plan sponsors—UnitedHealth, Humana, and CVS Health—account for more than half of the program’s 43 million Part D enrollees (55%) and two-thirds of all stand-alone drug plan enrollees, indicating a marketplace that is dominated by a handful of major insurers, according to a new Kaiser Family Foundation analysis of Part D enrollment, premiums and cost-sharing data. The proposed mergers of CVS Health and Aetna, and Cigna and Express Scripts would…

  • Medicare Payments and Beneficiary Costs for Prescription Drug Coverage

    Issue Brief

    This 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…

  • 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)

  • Issues for Medicare Beneficiaries in Long-Term Care Facilities: An Analysis of the MMA and Proposed Regulations

    Issue Brief

    This 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)

  • 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.