This issue brief provides an overview of Medicare, the health insurance program for people ages 65 and over and younger people with long-term disabilities. The brief review the characteristics of people on Medicare, what Medicare covers, benefit gaps and supplemental coverage, beneficiaries’ out-of-pocket health care spending, program spending and financing, payment and delivery system reform, and issues for the future of Medicare.
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Medicare Part D has helped to make prescription drugs more affordable for people with Medicare, yet many beneficiaries continue to face high out-of-pocket costs for their medications. Specialty tier drugs are a particular concern for Part D enrollees in this context. This analysis draws on data from Medicare’s Plan Finder website to calculate expected annual 2019 out-of-pocket costs for 30 specialty tier drugs used to treat four health conditions—cancer, hepatitis C, multiple sclerosis, and rheumatoid arthritis.
Medicare Part D Enrollees with Serious Health Conditions Can Face Thousands of Dollars in Out-of-Pocket Costs Annually for Specialty Drugs
Despite Medicare’s protections, Part D enrollees with serious health conditions can face thousands of dollars in annual out-of-pocket costs for expensive specialty drugs, a new KFF anaylsis finds. The analysis draws on data from Medicare’s Plan Finder website to calculate expected annual 2019 costs for more than two dozen specialty tier…
Today, 60 million people, including 51 million older adults and 9 million younger adults with disabilities, rely on Medicare for their health insurance coverage, but many Medicare beneficiaries rely on other sources of coverage to supplement their Medicare benefits. This data note explores sources of supplemental coverage among beneficiaries in traditional Medicare, based on data from the 2016 Medicare Current Beneficiary Survey.
A new Kaiser Family Foundation brief and interactive map provide the latest national and state-level estimates from the U.S. Census Bureau of the share and number of people ages 65 and older who are living in poverty. The resources examine poverty among seniors under the official poverty threshold ($11,756 in…
Comparing Poverty Rates under the Official Census Poverty Measure and the Supplemental Poverty Measure
This interactive graphic illustrates how poverty rates among seniors in each of the 50 states change under two different Census Bureau measures of poverty: the official poverty measure and an alternative supplemental poverty measure, which takes into account health care and housing costs among other factors.
This issue brief presents estimates of poverty under the Census Bureau’s official poverty measure and the Supplemental Poverty Measure for adults ages 65 and older, based on data for 2017 and three-year averages (2015 to 2017). Unlike the official poverty measure, the SPM poverty thresholds vary by geographic area and homeownership status, and the SPM reflects financial resources and liabilities, including taxes, the value of in-kind benefits (e.g., food stamps), and out-of-pocket medical spending. Estimates of poverty based on the SPM indicate that the number and share of older adults who are struggling financially are larger than when based on the official poverty measure.
A new brief from KFF (the Kaiser Family Foundation) examines potential changes to “spousal impoverishment” rules in Medicaid that allow married couples to protect a portion of their income and assets should one spouse seek Medicaid coverage for long-term care. A provision of the Affordable Care Act that requires state Medicaid…
Potential Changes to Medicaid Long-Term Care Spousal Impoverishment Rules: States’ Plans and Implications for Community Integration
Congress created the Medicaid spousal impoverishment rules to protect a portion of a married couple’s income and assets to provide for the “community spouse’s” living expenses when determining nursing home financial eligibility. Originally, states had the option to also apply the rules to home and community-based services (HCBS) waivers. Section 2404 of the Affordable Care Act (ACA), which is set to expire on December 31, 2018, changed the spousal impoverishment rules to treat Medicaid HCBS and institutional care equally. This issue brief answers key questions about the spousal impoverishment rules, presents selected 50-state data from a 2018 Kaiser Family Foundation survey about state policies and future plans in this area, and considers the implications if Congress does not extend Section 2404.
Most people with Medicare pay the standard monthly premium for Part B and Part D coverage, which is set to cover 25 percent of per capita program costs, but a relatively small share of beneficiaries with higher incomes are required to pay higher premiums. This issue brief describes the legislative history of Medicare’s income-related premiums and changes to these premiums that will take effect in 2019, based on a provision in the Bipartisan Budget Act of 2018.