Medicare

NEW AND NOTEWORTHY

What to Know About Medicare Coverage of Telehealth

Congress has repeatedly extended pandemic-era flexibilities around Medicare coverage of telehealth, but most such flexibilities remain temporary. This brief answers key questions about the current scope of Medicare telehealth coverage, including both temporary and permanent changes adopted through legislation and regulation, and future policy considerations.

Changes to the Medicare Advantage Program Enhance Some Consumer Protections But Roll Back Others

CMS recently finalized policies as part of the 2027 Medicare Advantage final rule that both enhance consumer protections and roll back changes to the Medicare Advantage program that were intended to protect consumers. These changes have gotten less attention than payment issues and changes to the star ratings system, which also affect plan payments, but could have implications for Medicare beneficiaries.

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. u003cbru003eu003cbru003eExplore 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.u003cbru003eu003cbru003eu003ca href=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022 data-type=u0022linku0022 data-id=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022u003eRelated:u003ca href=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022u003e FAQs on Medicare Financing and Trust Fund Solvencyu003c/au003eu003c/au003e

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  • Medicare Part D Enrollees with Serious Health Conditions Can Face Thousands of Dollars in Out-of-Pocket Costs Annually for Specialty Drugs

    News Release

    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 drugs used to treat four health conditions -- cancer, hepatitis C, multiple sclerosis and rheumatoid arthritis – based on coverage and costs in national and…

  • How Much Does Medicare Spend on Insulin?

    Issue Brief

    The price of insulin, used by people with both Type 1 and Type 2 diabetes to control blood glucose levels, has come under increasing scrutiny as policymakers grapple with rising drug costs. This data note finds spending on insulin by Medicare and beneficiaries enrolled in private Part D drug plans has increased sharply between 2007 and 2017.

  • Medicare Part D Spending on Insulin Increased 840 Percent Between 2007 and 2017

    News Release

    Medicare Part D spending on insulin increased 840 percent between 2007 and 2017, far outpacing growth in the number of beneficiaries using insulin therapy, according to a new KFF analysis. The findings come at a time when the cost of prescription drugs is a major focus for policymakers in Washington, with rising prices for insulin drawing particular scrutiny, including from members of Congress. Part D spending on insulin rose from $1.4 billion in 2007 to…

  • Medicare’s Income-Related Premiums Under Current Law and Changes for 2019

    Issue Brief

    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…

  • The New Health Care Agenda: Gridlock, Lots of Hearings

    From Drew Altman

    In an Axios column, Drew Altman analyzes what the midterm election means for the health policy agenda between now and 2020--mostly political positioning and gridlock in Congress, with most of the action affecting people in the states. 

  • Explainer Video Breaks Down Prescription Drug Rebates and Why They Matter in the Debate About Prescription Drug Costs

    News Release

    A new KFF animation explains how rebates for prescription drugs work, including how they are determined, who benefits from them, how they affect spending by insurers and consumers and the role of pharmacy benefit managers in the process. The Trump Administration had proposed banning such rebates in Medicare Part D, but dropped the proposal amid concerns that it would lead to higher costs for insurers, consumers and the Medicare program. It is still possible that…

  • Poll: Strong Initial Support for a Public Option, But Arguments Can Significantly Shift Views

    News Release

    Health Care Remains a Top Issue for Democrats Heading into Next Debates; At This Stage, More Want to Hear About Candidates’ Difference than Contrasts with President Trump The 2020 presidential election may be shaping up to be another election cycle focused on health care, with Democratic candidates offering competing proposals aimed at expanding coverage and controlling costs and a pending legal battle over the constitutionality of the Affordable Care Act. The latest KFF tracking poll…

  • As Policymakers Debate Medicare-for-All, Analysis Finds the Medicare Advantage, Individual and Group Health Insurance Markets Appear to Be Profitable, Especially Medicare Advantage

    News Release

    Three key private health insurance markets -- Medicare Advantage, the individual market and the fully-insured group market -- appear to be financially healthy and attractive to insurers, according to a new KFF analysis. The private Medicare Advantage market generates significantly larger gross margins per person than the individual market or fully-insured market, the analysis finds. The future of these markets has become a focus for policymakers amid the debate over Medicare for All. Some proposals…

  • How Many People with Employer-Sponsored Insurance Use the Drugs Slated for Medicare Price Negotiations

    Issue Brief

    Among the 167 million people with employer-sponsored insurance in 2022, 3.4 million used at least one of the first 10 drugs identified for Medicare price negotiations, according to a new analysis. The most used drug for people with employer-sponsored health insurance was Jardiance, a drug used to treat diabetes and heart failure, which was taken by more than 911,000 enrollees. The analysis uses the Merative MarketScan 2022 commercial claims to estimate the number of enrollees…