Mental Health and Substance Use Disorder Coverage in Medicare Advantage Plans April 28, 2023 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.
Access Problems And Cost Concerns Of Younger Medicare Beneficiaries Exceeded Those Of Older Beneficiaries In 2019 April 3, 2023 Issue Brief Published in the journal Health Affairs, this analysis compared measures of access to care, cost concerns, and satisfaction with care for beneficiaries younger than age sixty-five versus those ages sixty-five and older, using the 2019 Medicare Current Beneficiary Survey.
Increasingly Privatized Public Health Insurance Programs in the US March 30, 2023 Perspective In this JAMA Forum column, KFF’s Larry Levitt examines the growing role of private insurance companies in public programs, including Medicare Advantage and Medicaid managed care, and the tradeoffs that result.
March 21 Web Event: Unpacking the Controversy Over Medicare Advantage March 21, 2023 Event Medicare Advantage is the rapidly growing private plan alternative to traditional Medicare that provides coverage to approximately half of Medicare beneficiaries. Controversy has arisen over a Biden Administration proposal for changes to payments to insurers for the coming year, including how the health risk of enrollees is captured, as well…
Medicare Advantage Insurers Report Much Higher Gross Margins Per Enrollee Than Insurers in Other Markets February 28, 2023 News Release 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…
Health Insurer Financial Performance in 2021 February 28, 2023 Issue Brief Using health insurer financial data for 2021, we find that Medicare Advantage insurers reported gross margins that were at least twice as high as those reported by insurers in the individual/non-group, fully-insured group/employer, and Medicaid managed care markets. The four markets report similar simple medical-loss-ratios.
Is the Biden Administration Proposing Cuts to Medicare Advantage? February 17, 2023 Blog Recent announcements by the Administration to improve the accuracy of payments and improve program integrity of Medicare Advantage are unlikely to have a major impact on the program, the insurance industry or beneficiaries, given relatively generous payments to plans and the robustness of the market for private Medicare plans.
The End of the COVID-19 Public Health Emergency: Details on Health Coverage and Access February 3, 2023 Blog This post provides an overview of how health care coverage and access will and won’t change when the public health emergency ends on May 11, including a discussion of COVID-19 vaccines, tests, and treatments, and telemedicine.
Medicare Advantage Plans Denied 2 Million Prior Authorization Requests in 2021, About 6% of Such Requests February 2, 2023 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…
Over 35 Million Prior Authorization Requests Were Submitted to Medicare Advantage Plans in 2021 February 2, 2023 Issue Brief We analyze data from CMS to examine the number and outcome of Medicare Advantage prior authorization requests in 2021, overall and by firm.