Medicare

New & 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.

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.

Related: FAQs on Medicare Financing and Trust Fund Solvency

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  • Higher and Faster Growing Spending Per Medicare Advantage Enrollee Adds to Medicare’s Solvency and Affordability Challenges

    Issue Brief

    This analysis finds that Medicare spending for Medicare Advantage enrollees was $321 higher per person in 2019 than if enrollees had instead been coverage by traditional Medicare, leading to an estimated $7 billion in additional spending in 2019. It also examines the implications of expected growth in Medicare Advantage enrollment and payments per enrollee from 2021 to 2029.

  • What’s the Latest on Medicare Drug Price Negotiations?

    Issue Brief

    In response to prescription drug spending growth and heightened attention to drug prices, some policymakers have proposed allowing the federal government to negotiate the price of prescription drugs for Medicare and private payers. This brief describes the current status of drug price negotiation proposals, looks back at the history of proposals to give the federal government the authority to negotiate drug prices in Medicare, describes the negotiation provisions in key legislation (H.R. 3), and discusses the potential spending effects for the federal government, beneficiaries, and private payers.

  • A Small Number of Drugs Account for a Large Share of Medicare Part D Spending

    Issue Brief

    The Inflation Reduction Act requires the federal government to negotiate the price of certain high-spending drugs covered by Medicare. This analysis provides context for understanding the potential impact of negotiating prices for a limited number of Medicare-covered drugs by identifying the 10 top-selling Part D drugs in 2021, measuring the share of total Part D drug spending accounted for by top-selling drugs that year, and examining changes in spending and use of these drugs since 2018.

  • New Weight Loss Drugs Raise Issues of Coverage, Cost, Access and Equity

    Event Date:
    Event

    New weight loss drugs, such as Novo Nordisk’s Ozempic and Wegovy (semaglutide) and Eli Lilly’s Mounjaro (tirzepatide), could be transformative for people who struggle with obesity and obesity-related medical conditions, but there are major questions to consider related to insurance coverage, the cost of the drugs, and who has access. On August 4, three experts joined Larry Levitt, executive vice president for health policy at KFF, for a 45-minute “Health Wonk Shop” discussion about the questions surrounding what a new generation of weight loss drugs means for patients and payers.

  • Kaiser /Harvard Survey of Americans on Health Policy

    Poll Finding

    A telephone survey of 1,011 adults (between June 20 and July 9, 1996) about how health care reform (specifically Medicare reform, MSAs and the Kassebaum/Kennedy bill) fits into the upcoming November election. The survey was designed by the Kaiser Family Foundation, Harvard University, and Princeton Survey Research Associates (PSRA). The survey was conducted by PSRA.

  • Consumer Protection Issues in Medicare + Choice

    Report

    This report describes and analyzes key Medicare+Choice provisions in the Balanced Budget Act and the accompanying regulations related to consumer protections. It explains how the BBA makes significant improvements for beneficiaries in the areas of access, appeals, and quality.