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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  • A Side-by-Side Comparison of Selected Medicare Prescription Drug Coverage Proposals

    Report

    This document provides a side-by-side comparison of four major federal proposals under consideration to provide outpatient prescription drug coverage to Medicare beneficiaries. It begins with a summary table comparing key features of each proposal, followed by a detailed comparison of the following major proposals: Clinton/Moynihan (The Medicare Modernization Act), House-Passed Plan (The Medicare Rx 2000 Act), Breaux/Frist (The Medicare Prescription Drug and Modernization Act), and Graham/Bryan/Robb (The Medicare Outpatient Drug Act of 2000). Side-by-side

  • The Role of PBMs in Managing Drug Costs: Implications for a Medicare Drug Benefit

    Other Post

    Extending a drug benefit to Medicare beneficiaries has been a highly publicized issue in recent months. To address the question of how to finance and administer such a benefit while controlling its cost, some have proposed using pharmacy benefit managers (PBMs)--companies that administer pharmaceutical benefits for health plans, HMOs, and employers while managing drug utilization and obtaining discounts from both retail pharmacies and manufacturers. Most recently, the Clinton Administration introduced a proposal for a Medicare…

  • Dementia and Medicare Managed Care: A Growing Challenge for Health Plans

    Report

    The American Bar Association Commission on Legal Problems of the Elderly explored the views of Medicare HMOs on enrolling and delivering services to Medicare beneficiaries with dementia. The Commission conducted detailed interviews with professionals at eight diverse Medicare+Choice organizations. Their report provides background information on health care decision-making law and the Medicare program's laws and regulations, and focuses on survey findings in six key areas: marketing, enrollment, health assessments, health care delivery, advance directives, and…

  • Medicaid Managed Care for Persons with Disabilities: A Closer Look

    Report

    This report, Medicaid Managed Care for Persons with Disabilities: A Closer Look, presents an overview of the findings and summarizes the results of the case studies of Medicaid managed care programs that enroll persons with disabilities in four states: Florida, Kentucky, Michigan, and New Mexico. This report also draws from the findings of the 1998 national survey of state practices (Publication #2114) and focus groups of low-income disabled individuals (Publication #2152). This report addresses the…

  • Medicare Restructuring: The FEHBP Model – Report

    Report

    Medicare Restructuring: The FEHBP Model Executive Summary As policymakers consider measures to assure the long-range solvency of Medicare, one option that has received increasing attention is a "premium support" system. Under such a system beneficiaries would choose between the original Medicare fee-for-service program and a variety of competing health plans. They would receive a fixed government contribution toward the plan of their choice and would pay any remaining costs themselves. Proponents of a premium support…

  • Prescription Drug Coverage for Medicare Beneficiaries: A Side-by-Side Comparison of Selected Proposals

    Report

    Updated, July 31, 2002 This document, prepared by Health Policy Alternatives, Inc., provides a side-by-side comparison of five major federal proposals to provide outpatient prescription drug coverage to Medicare beneficiaries, introduced as of July 31, 2002: H.R. 4954, The Medicare Modernization and Prescription Drug Act of 2002 (passed by the House of Representatives on June 28, 2002); H.R. 5019, The Medicare Rx Drug Benefit and Discount Act of 2002 (Rep. Rangel/House Democratic proposal); S. 2625,…

  • The Medicare Program: Servicios De Salud Administrados Por Medicare

    Fact Sheet

    Panorama General: Medicare proporciona servicios de salud a casi 39 millones de norteamericanos, incluyendo aproximadamente a 34 millones de ancianos y a 5 millones de discapacitados. La gran mayoria de estas personas cubren sus gastos medicos directamente mediante el programa tradicional de "pago por servicio," mientras que el 15 porciento restante (mas de 5 millone de beneficiarios) estan cubiertos bajo algun plan de servicio medico contratado con Medicare, principalmente las organizaciones de administracion de la…

  • Medicare Beneficiaries and HMOs: A Case Study of the Tampa-St. Petersburg Market

    Report

    This case study of the evolution of Medicare managed care in Tampa-St. Petersburg, Florida, is one of four in a series being prepared by Mathematica Policy Research, Inc., for the Kaiser Family Foundation to examine the growth and impact of Medicare managed care. The Medicare risk (HMO) program has developed at different rates and with different degrees of success across the country. The four unique market areas selected for the project include two with high…