Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023 January 28, 2025 Issue Brief Nearly 50 million prior authorization requests were submitted to Medicare Advantage insurers on behalf of Medicare Advantage enrollees in 2023, of which 3.2 million (6.4%) were denied. Just 11.7% of denied requests were appealed, though 81.7% of appeals overturned the initial denial in Medicare Advantage. Substantially fewer prior authorization requests were made in traditional Medicare, reflecting the small number of services subject to prior authorization requirements.
Medicare Part D Enrollees Without Low-Income Subsidies (LIS) With Drug Spending Above the Catastrophic Threshold January 19, 2024 State Indicator
Average Drug Fills and Average Gross Drug Costs Per Medicare Part D Enrollee May 4, 2023 State Indicator
The Bigger Story, and Agenda, Behind GOP Changes to Obamacare, Medicare and Medicaid November 21, 2016 Perspective 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…
How the Republican Health Agenda Could Play Out December 2, 2016 Perspective In this Wall Street Journal Think Tank column Drew Altman discusses how Republicans will assume ownership of health care’s policy and political problems as they assume control, and how that may affect their plans for the Affordable Care Act, Medicaid and Medicare.
The Republican Health-care Plan the Country Isn’t Debating February 9, 2017 Perspective In this Washington Post op-ed, Drew Altman discusses how Republicans’ ideas to change Medicaid and Medicare and repeal the Affordable Care Act would fundamentally change the federal role in health, calling it: the biggest change in health we are NOT debating.
Medicaid’s Role for Medicare Beneficiaries February 16, 2017 Issue Brief This brief outlines Medicaid’s role for Medicare beneficiaries. It describes the role that Medicaid plays for 10 million Medicare beneficiaries to help inform upcoming debates about proposals to restructure Medicaid financing in ways that could reduce federal funding.
11 Million People on Medicare Are Also Covered by Medicaid. What Could Switching to a Medicaid Per Capita Cap Mean for Them? March 20, 2017 News Release A major structural change to Medicaid financing such as the per capita cap system called for under the American Health Care Act could have significant implications for the 11 million seniors and people with disabilities who are covered by both Medicare and Medicaid, according to a new brief by the…
What Could a Medicaid Per Capita Cap Mean for Low-Income People on Medicare? March 24, 2017 Issue Brief Policymakers are currently considering proposals that would fundamentally change the structure and financing of Medicaid, and potentially affect 11 million people on Medicare. This brief discusses the potential implications of Medicaid per capita cap or block grant proposals for the 11 million low-income seniors and people with disabilities on Medicare. It also describes how the per capita cap model proposed in the American Health Care Act could potentially affect low-income people on Medicare who receive assistance from Medicaid.
Medicare Program Integrity and Efforts to Root Out Improper Payments, Fraud, Waste and Abuse March 31, 2025 Issue Brief This brief explains fraud, waste, abuse, and improper payments in Medicare and describes actions to ensure Medicare program integrity.
