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This study assesses the impact of the requirement that low-income people with Medicare meet an asset test in order to receive additional help paying premiums and cost-sharing under the new Medicare drug benefit. Report (.
This data spotlight examines enrollment trends in Medicare Advantage plans in 2011 and finds that, despite concerns about the effects of the 2010 health reform payment reductions on private Medicare Advantage plans, enrollment continued to rise this year. Additionally, Medicare Advantage enrollees are paying lower premiums, on average, than they did in 2010.
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.
This primer explains key elements of the Medicare program, which now provides health coverage to 55 million people -- including 46 million people age 65 and older and another 9 million younger adults with permanent disabilities. It looks at the characteristics of the Medicare population, what benefits are covered, how much people with Medicare pay for their benefits and the program’s overall costs and future financing challenges.
This report examines similarities and differences in federal consumer protection standards for Medicare Advantage (MA) plans, Qualified Health Plans (QHPs), and Medicaid Managed Care Organizations (MCOs). It focuses on rules established at the federal level, though some states have chosen to go above the federal minimums and impose additional requirements for QHPs and Medicaid MCOs.
This report examines the Center for Medicare and Medicaid Services (CMS) financial alignment demonstration for beneficiaries dually eligible for Medicare and Medicaid, with a focus on the extent to which participating states and health plans have prior experience with capitated managed care arrangements under Medicare or Medicaid, and specifically for this population. Under these capitated financial alignment demonstrations, health plans contract with the state and CMS (a three-way contract) to provide both Medicare and Medicaid benefits to dually eligible beneficiaries. These demonstrations aim to improve the quality of care and the coordination of benefits for people dually eligible for Medicare and Medicaid. The report finds considerable variation in the experience of states and health plans participating in these demonstrations, and discusses the potential implications for beneficiaries and plan oversight.
The House-passed legislation to repeal the Medicare Sustainable Growth Rate (SGR) includes a provision that would prohibit Medicare supplemental insurance (Medigap) policies from covering the Part B deductible for people who become eligible for Medicare beginning in 2020.
This 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.
When the federal government ends COVID-19 emergency declarations that were declared in the early days of the pandemic, it will bring to a close several changes that were enacted temporarily to enable the U.S. health care system to better deal with the crisis.
A new analysis of health insurers’ 2021 financial data shows that insurers continue to report much higher gross margins per enrollee in the Medicare Advantage market than in other health insurance markets. The analysis examines insurers’ financial data in the Medicare Advantage, Medicaid managed care, individual (non-group), and fully insured group (employer) markets.
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