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This data note discusses the impact of the 2025 reconciliation law on nursing facilities and examines the characteristics of nursing facilities and the people living in them with data from Nursing Home Compare, a publicly available dataset.
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.
A number of potential mergers and acquisitions between large firms that offer health insurance have been reported in the press. These mergers could affect consumers in the individual market, enrollees in the new federal and state Marketplaces, employees with employer-sponsored insurance, as well as people covered by public programs such as Medicare. This Data Note examines the Medicare Advantage market share of large firms that have reportedly engaged in merger and acquisition discussions: Aetna, Anthem, Cigna, Humana, and UnitedHealthcare.
To financially qualify for Medicaid long-term services and supports (LTSS), an individual must have a low income and limited assets. In response to concerns that these rules could leave a spouse without adequate means of support when a married individual needs LTSS, Congress created the spousal impoverishment rules in 1988. Originally, these rules required states 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, but gave states the option to apply the rules to home and community-based services (HCBS) waivers.
Section 2404 of the Affordable Care Act (ACA) changed the spousal impoverishment rules to treat Medicaid HCBS and institutional care equally from January 2014 through December 2018. Congress subsequently extended Section 2404 through December 2019. This issue brief answers key questions about the spousal impoverishment rules, presents 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 further extend Section 2404.
These FAQs address questions related to prescription drug importation, including the current status of importation proposals, details of Florida’s importation program recently authorized by the FDA, and concerns and challenges with this approach.
This analysis provides a detailed look at per person Medicare spending on the nearly 30 million beneficiaries over age 65 who are enrolled in the traditional Medicare program. Among the key findings of the report is that per person spending rises with age, peaking at age 96. But this rise is not entirely explained by Medicare spending on end of life care, which declines with age. What Medicare spends money on also changes as beneficiaries age. Hospital care is the largest component of Medicare spending throughout the age curve, up to age 100, but there is less spending on physician services and more on home health, skilled nursing and hospice care as beneficiaries age.
A small share of the 52.4 million elderly individuals and people with disabilities on Medicare have relatively high incomes, but most are of modest means -- with half living on incomes of less than $23,500 last year.
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 analysis provides the latest data about Medicare Part D coverage and costs in 2019 and trends over time, including enrollment, premiums, cost sharing, and participation in the low-income subsidy program.
This issue brief presents FY 2020 state-level data on the number of people receiving Medicaid HCBS and HCBS spending. This is the latest data available, and the first since the onset of the COVID-19 pandemic. The data were collected in KFF’s 19th survey of state officials administering Medicaid HCBS programs in all 50 states and DC. A related brief presents the latest data and highlights themes in key state policy choices about optional HCBS.
This issue brief highlights key differences between Medicare and Medicaid and raises questions about how a policy to lower the age of Medicare eligibility could affect individuals who are currently enrolled in Medicaid.
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