President Donald Trump and the GOP congressional leaders have talked about modernizing Medicare, including a proposal from House Republicans to create a premium-support system for Medicare.  In the wake of passage of the GOP tax bill, which is expected to add to the national debt, there may be a focus on reining in the cost of entitlement programs such as Medicare, which may have significant implications for the Medicare program and its beneficiaries. The Trump administration also has shown interest in prescription drug spending in Medicare as well as in Medicare delivery system reform efforts such as Accountable Care Organizations, bundled payments and medical homes. Medicare Advantage now covers 1 in 3 Medicare beneficiaries and recent trends toward consolidation among insurers could have implications for beneficiaries.
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Paying a Visit to the Doctor: Current Financial Protections for Medicare Patients When Receiving Physician Services

This issue brief explains provisions in current law that shield beneficiaries from unexpected and confusing charges when they see physicians and practitioners—namely, the participating provider program, limitation on balance billing, and conditions on private contracting for doctors who opt out of Medicare or join “concierge” practices. It also analyzes the implications of modifying these provisions for beneficiaries, providers, and the Medicare program.

The Bigger Story, and Agenda, Behind GOP Changes to Obamacare, Medicare and Medicaid

This column was published as a Wall Street Journal Think Tank column on November 21, 2016. Early media coverage of the Republican health-care agenda has concentrated on plans to repeal and then replace the Affordable Care Act. The larger story is GOP preparations for a health policy trifecta: to fundamentally change the…

Payment and Delivery System Reform in Medicare: A Primer on Medical Homes, Accountable Care Organizations, and Bundled Payments

This primer providers an overview of certain delivery system reform models that are being examined in traditional Medicare, and explains model goals, financial incentives, potential beneficiary implications, and results so far with respect to Medicare spending and care quality. The primer discusses accountable care organizations, medical homes and bundled payments.

Where President-elect Donald Trump Stands on Six Health Care Issues

Where does President-elect Donald Trump stand on key health care issues? This snapshot outlines his positions and policy statements during the campaign on issues such as health insurance, the ACA, Medicaid, Medicare, the opioid epidemic, prescription drug costs, and women’s reproductive health.

The Gap in Medigap

This policy insight examines the low rate of Medigap coverage among people under age 65 with disabilities on Medicare and the federal law that governs consumer rights and protections related to Medigap open enrollment.

Turning Medicare Into a Premium Support System: Frequently Asked Questions

Premium support is a general term used to describe an approach to reform Medicare that aims to reduce the growth in Medicare spending. These FAQs raise and discuss basic questions about the possible effects of a premium support system for Medicare beneficiaries, the federal budget, health care providers, and private health plans.

Questions and Answers about Turning Medicare into a Premium Support System

With its inclusion in the House GOP health plan released last month, the idea of converting Medicare into a premium support system once again features prominently in Capitol Hill policy discussions about the future of Medicare, the federal health insurance program that covers 57 million seniors and people with disabilities.…

Medicare’s Income-Related Premiums: A Data Note

This data note presents new information to help set a context for understanding the implications of recent changes to Medicare’s income-related premiums incorporated in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a new law to repeal and replace Medicare’s Sustainable Growth Rate (SGR) formula for physician payments. It describes current requirements with respect to the income-related premiums under Medicare Part B and Part D, including the number and share of Medicare beneficiaries who are estimated to pay income-related premiums and revenues raised from the income-related premium, based on data from the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary (OACT). It also explains the recently enacted changes in MACRA that will affect some higher-income people on Medicare who are already paying income-related premiums, beginning in 2018.