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  • What Do People with Medicare Think About the Role of Marketing, Shopping for Medicare Options, and Their Coverage?

    Report

    To capture Medicare beneficiaries’ views and experiences in choosing between traditional Medicare and private plans, and among private plans, and the factors that influence these decisions, KFF worked with PerryUndem to conduct focus groups with Medicare beneficiaries in the Fall of 2022, during the annual Medicare open enrollment period. This report summarizes first-hand accounts of participants’ reactions open enrollment advertising and factors that influence their decision-making around Medicare plan choice.

  • Medicare Advantage Enrollment, Plan Availability and Premiums in Rural Areas

    Issue Brief

    Medicare Advantage enrollment is lower, but has grown more rapidly in recent years in rural areas than in metropolitan areas. In 2023, nearly 40% of eligible Medicare beneficiaries in rural areas are in Medicare Advantage. Rural Medicare beneficiaries can choose from 27 Medicare Advantage plans on average and most are enrolled in a plan that charges no additional premium.

  • How Do Dual-Eligible Individuals Get Their Medicare Coverage?

    Issue Brief

    People who are dually eligible for both Medicare and Medicaid coverage can get their Medicare coverage in a variety of ways. The brief breaks out the data for traditional Medicare, Medicare Advantage plans that are available to all Medicare beneficiaries, and plans that are designed specifically for dual-eligible beneficiaries.

  • New OIG Report Examines Prior Authorization Denials in Medicaid MCOs

    Policy Watch

    Congress asked the U.S Department of Health and Human Services (HHS) Office of the Inspector General (OIG) to investigate whether Medicaid MCOs are providing medically necessary health care services to their enrollees. OIG found that Medicaid MCOs had an overall prior authorization denial rate of 12.5%–more than 2 times higher than the Medicare Advantage rate. Prior authorization denial rates ranged widely across and within parent firms and states. After a prior authorization request is denied, Medicaid enrollees can appeal, but it’s not always straightforward and many appeals don’t change the initial decision. Unlike in Medicare Advantage, if a Medicaid MCO upholds its original denial, there is no automatic, independent external medical review. OIG found that state Medicaid agency oversight of prior authorization denials is limited. The OIG report underscores concerns about prior authorization and access in Medicaid managed care, keeping this issue at the forefront of ongoing policy discussions.

  • Key Facts About Medicare Part D Enrollment and Costs in 2023

    Issue Brief

    The Medicare Part D program provides an outpatient prescription drug benefit to older adults and people with long-term disabilities in Medicare who enroll in private plans. This brief analyzes Medicare Part D enrollment and costs in 2023 and trends over time. The analysis highlights the substantial growth of Medicare Advantage drug plans in the marketplace for Part D drug coverage, where enrollment overall is concentrated in a handful of large plan sponsors.

  • Testimony: Prior Authorization in Medicare Advantage

    Issue Brief

    Jeannie Fuglesten Biniek, an Associate Director for the Program on Medicare Policy at KFF, testified before the Senate Homeland Security and Government Affairs Committee Permanent Subcommittee on Investigations on May 17, 2023 as part of a hearing on Examining Health Care Denials and Delays in Medicare Advantage.

  • 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.

  • Mental Health and Substance Use Disorder Coverage in Medicare Advantage Plans

    Issue Brief

    This brief describes the scope of mental health and substance use disorder benefits in Medicare Advantage plans, including extra benefits, cost sharing, and prior authorization and referral requirements, based on an analysis of the Centers for Medicare and Medicaid Services (CMS) Medicare Advantage plan benefit and enrollment files for 2022.