Medicare

Medicare Open Enrollment

Medicare Advantage Plan Availability Varies Widely by County for 2027

Medicare Advantage prescription drug plan (MA-PD) availability varies widely by county in 2027, with a modest reduction in the share of enrollees with more than 40 plans to choose from and some major insurers exiting many more counties than they are entering. 1 in 5 Medicare beneficiaries (20%) can choose from among more than 40 MA-PDs for 2027, down from 27% in 2026. 1% of all beneficiaries will have no plan option for 2027.

Medicare Open Enrollment and Coverage Options: Key Questions and Answers

Each year, Medicare beneficiaries have an opportunity to make changes to how they receive their Medicare coverage during the nearly 8-week annual open enrollment period, which runs from October 15 through December 7. This brief answers key questions about the Medicare open enrollment period and Medicare coverage options.

Medigap

Medigap Guaranteed Issue Requirements: An Overview of Federal and State Rules

This issue brief analyzes federal and state rules related to guaranteed issue requirements for Medigap policies and how they impact beneficiaries’ access to Medigap, including the implications for Medicare beneficiaries with pre-existing medical conditions and those under age 65 with long-term disabilities.

NEW AND NOTEWORTHY

Decoding Medicare Advantage Coding Intensity

Federal payments to Medicare Advantage plans, and adjustments for health status, have come under increased scrutiny. This brief answers key questions about coding intensity, recent steps taken by CMS, the effects on beneficiaries, and other proposals to improve payment accuracy.

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 Effects of Formularies and Other Cost Management Tools on Access to Medications:  An Analysis of the MMA and the Final Rule

    Issue Brief

    This report examines the formulary and cost management provisions of the final Medicare regulations implementing the new Medicare Part D drug benefit that was passed as part of the Medicare Modernization Act of 2003, and their implications for people with Medicare who enroll in new drug plans and their access to medications. It was prepared for the Foundation by Jack Hoadley, Ph.D., of the Health Policy Institute at Georgetown University. Issue Brief (.pdf)

  • Dual Eligibles and Medicare Part D

    Issue Brief

    This snapshot summarizes the latest information and policy issues about the enrollment of dual eligibles into the Medicare prescription drug benefit. Issue Brief (.pdf)

  • Proposed Changes to Medicare in the “Path to Prosperity”: Overview and Key Questions

    Issue Brief

    This brief examines key Medicare provisions included in "The Path to Prosperity: Restoring America's Promise," a long-term budget proposal released by House Budget Chairman Paul Ryan on April 5, 2011, which outlines a strategy for reducing federal spending and reducing the national debt over time. The Medicare provisions are among the many significant changes to programs affecting the elderly and disabled in the "Path to Prosperity" proposal. The central Medicare proposal would transform the program…

  • Pulling It Together: Are We Headed for a Government Takeover of Health Care?

    Perspective

    Remember the “government takeover of the health care system” argument that critics of the health reform law have used?  Well, last week the Office of the Actuary in the Centers for Medicare and Medicaid Services published the latest projections of health spending in the journal Health Affairs.  Attention focused mainly on the Actuary’s estimate that national health spending would grow to almost 20% of GDP by 2020 and that the Affordable Care Act (ACA) would…

  • The Budget Control Act of 2011: Implications for Medicare

    Issue Brief

    Beginning January 2013, Medicare spending will be subject to automatic, across-the-board reductions, known as “sequestration,” which is slated to reduce Medicare payments to plans and providers by up to 2 percent. This sequestration results from provisions in the Budget Control Act of 2011, which raised the debt ceiling and will reduce net federal spending by $2.1 trillion over ten years. The Act was a bipartisan compromise negotiated between the Administration and Congressional leaders, just before…

  • Firm Perspectives on the Medicare Advantage Market

    Issue Brief

    Based on interviews with senior executives at 14 large firms, the issue brief finds that insurers anticipate continuing to offer Medicare Advantage plans in 2012, in part because of a Medicare demonstration project that will award bonus payments to plans based on their quality standards. A companion issue brief examines trends in Medicare Advantage enrollment in 2011. The analysis was conducted by researchers at Mathematica Policy Research, Inc. and the Kaiser Family Foundation. Issue Brief…

  • Medicare Beneficiaries & HMO’s:  A Case Study of the Portland, OR Market

    Other Post

    Medicare Beneficiaries & HMO's: A Case Study of the Portland, OR Market Note: This publication is no longer in circulation. However, a few copies may still exist in the Foundation's internal library that could be xeroxed. Please email order@kff.org if you would like to pursue this option