Medicare

NEW AND NOTEWORTHY

Examining the Potential Impact of Medicare’s New WISeR Model

A federal initiative to establish new prior authorization requirements in traditional Medicare, called the Wasteful and Inappropriate Service Reduction (WISeR) model, is likely to have only modest impact in its first year.

State Profiles for Dual-Eligible Individuals

This data collection draws on Medicare and Medicaid administrative data to present national and state-level information on people who are covered by both Medicare and Medicaid, referred to as dual-eligible individuals (also known as dually-enrolled beneficiaries).

Data Visualization

The Facts About Medicare Spending

This interactive provides the facts on Medicare spending. Medicare, which serves 67 million people and accounts for 12 percent of the federal budget and 21 percent of national health spending, is often the focus of discussions about health expenditures, health care affordability and the sustainability of federal health programs. Explore data on enrollment growth, Medicare spending trends overall and per person, growth in Medicare spending relative to private insurance, spending on benefits and Medicare Advantage, Part A trust fund solvency challenges, and growth in out-of-pocket spending by beneficiaries.

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  • The Role of High-Income Seniors in Medicare Reforms: The Public’s Perspective

    Feature

    Medicare remains in the spotlight as policymakers and presidential candidates look for ways to rein in Medicare spending. One facet of the debate has centered on whether seniors with higher incomes should pay more for their coverage under Medicare. Based on data from the February 2012 Health Tracking Poll, this data note examines at what income level the public sees seniors as 'wealthy,' and finds that the answer has a lot to do with how…

  • How Does the Benefit Value of Medicare Compare to the Benefit Value of Typical Large Employer Plans?: A 2012 Update

    Issue Brief

    This study compares the value of Medicare's fee-for-service benefits last year with the value of benefits in two large employer health plans -- a large health plan serving federal employees and a typical large employer Preferred Provider Organization (PPO) plan. For individuals ages 65 and older, the study finds that Medicare remains less generous on average than typical large employer health plans, even after recent improvements in the program's drug coverage. Overall, Medicare would cover…

  • Medicare’s Role for Dual Eligible Beneficiaries

    Issue Brief

    About 9 million low-income seniors and younger people with disabilities in the United States are covered by both Medicare and Medicaid. This brief examines the role of Medicare in providing health coverage for these beneficiaries. Medicare is the primary source of health insurance, while Medicaid provides supplemental coverage, helping with premiums and cost-sharing and paying for services not covered by Medicare. This brief examines overall and per capita Medicare spending for these beneficiaries, including variations…

  • An Update on CMS’s Capitated Financial Alignment Demonstration Model For Medicare-Medicaid Enrollees

    Issue Brief

    Beginning in January, 2013, the Centers for Medicare and Medicaid Services (CMS) will implement a three year multi-state demonstration to test new service delivery and payment models for people dually eligible for Medicare and Medicaid. These demonstrations will enroll full dual eligibles in managed fee-for-service or capitated managed care plans that seek to integrate benefits and align financial incentives between the two programs. On January 25, 2012, CMS issued a memorandum providing additional guidance for…

  • Among Dual Eligibles, Identifying The Highest Cost Individuals Could Help In Crafting More Targeted And Effective Responses

    Report

    This Health Affairs article by researchers at the Urban Institute analyzes linked Medicare and Medicaid data to examine dual eligibles' utilization and spending in both programs in 2007. It finds that while the population of people dually eligible for Medicare and Medicaid is indeed costly, it is not monolithic. For instance, although 20 percent of dual eligibles accounted for more than 60 percent of combined Medicaid and Medicare spending, nearly 40 percent of dual eligibles…

  • The Diversity of Dual Eligible Beneficiaries: An Examination of Services and Spending for People Eligible for Both Medicaid and Medicare

    Issue Brief

    This issue brief analyzes linked Medicare and Medicaid data to examine dual eligibles' utilization and spending in both programs in 2007. As a group, dual eligibles are costly—with per capita Medicare and Medicaid spending over four times Medicare spending for other beneficiaries. However, a small share of dual eligibles account for most of the group's spending, and dual eligibles who are high cost to the Medicare program are generally not the same individuals who are…

  • Key Issues in Understanding the Economic and Health Security of Current and Future Generations of Seniors

    Issue Brief

    As part of broad deficit-reduction plans, policymakers are considering reforms to the nation's three major entitlement programs - Medicare, Medicaid and Social Security - that could significantly affect the economic security of seniors in their retirement years. This brief examines the role of these programs in ensuring seniors' financial security as well as the challenges facing current and future generations when it comes to economic and health security. Drawing from current research and data, the…

  • Kaiser Health Tracking Poll — February 2012

    Feature

    In the midst of continuing debate on the future of the Medicare program, the February Kaiser Family Foundation Tracking Poll finds most Americans and most seniors favor the status quo, though arguments about the program’s solvency have the potential to sway opinion toward new proposals. The survey also gauges public opinion about the ongoing contraceptive coverage debate, views of the Affordable Care Act, and trust in the presidential candidates on health care issues. The February…

  • Betting on Private Insurers

    Perspective

    Just-released estimates of national health spending in 2010 by the Centers for Medicare and Medicaid Services (CMS) show that 45% of our health care spending is financed by the federal and state governments, primarily through the Medicare and Medicaid programs. This share has grown temporarily in recent years because of the economic downturn, as private insurance has declined and Medicaid has grown. It has also increased due to our demographic destiny: the growing cohort of baby…

  • Talking About Medicare: Your Guide to Understanding the Program, 2012

    Report

    Medicare is the federal health insurance program for people 65 and older and for some younger adults with permanent disabilities and medical conditions.  Prior to 1965, the year in which the Medicare program was established, about half of all seniors lacked health insurance.  Today, virtually all people 65 and older have coverage under Medicare, and are eligible for this coverage without regard to their income or medical history.  Medicare currently provides health insurance coverage for…