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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.

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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 Impact of Cost Sharing on Appropriate Utilization and Health Status: A Review of the Literature on Seniors

    Other Post

    The Impact of Cost-Sharing on Appropriate Utilization and Health Status: A Review of the Literature on Seniors This article provides a review of research that has addressed the impact of patient cost-sharing on the use of health care services and subsequent health status for those ages 65 and older. Twenty-two studies are reviewed -- 16 focusing on cost-sharing for prescription drugs and 6 on cost-sharing for medical services. The article concludes that most studies examined…

  • Dual Eligible Home and Community-Based Waiver Program Participants and the New Medicare Drug Benefit

    Issue Brief

    Dual eligible beneficiaries who participate in Medicaid home and community-based waiver programs usually do not have a centralized care provider to manage their health care benefits and services. For the new Medicare prescription drug benefit, no individual is designated to assist participants with their prescription drug plan selection, comparison of formularies, and if necessary, management of their exceptions and appeals should a medication be denied by their plan. This paper offers state and federal policymakers…

  • Medicare Prescription Drug Coverage for Residents of Nursing Homes and Assisted Living Facilities: Special Problems and Concerns

    Issue Brief

    This issue brief describes Medicare drug benefit policy issues for residents of nursing homes and other long-term care settings, such as assisted living facilities and board and care facilities. The brief addresses differing rules for nursing home and non-nursing home settings, as well as for dual eligibles residing in long-term care facilities. Issue Brief (.pdf)

  • Medicare+Choice Withdrawals: Understanding Key Factors

    Report

    To help understand why M+C plans have exited or limited their participation in the M+C program in recent years, this report presents an empirical analysis of the factors associated with plan withdrawals between 1999 and 2001. This analysis explores factors such as M+C payment levels, local market characteristics, and individual health plan characteristics to help predict plan withdrawals and draw inferences about the types of plans and markets that have been most adversely affected. Report

  • Selected Findings on Knowledge and Understanding of the New Medicare Rx Drug Program — January/February 2004 Kaiser Health Poll Report Survey

    Poll Finding

    Seniors are confused about the Medicare prescription drug law. Selected findings from the January/February 2004 Kaiser Health Poll Report survey show that while about two-thirds of seniors report following the debate closely, just 15% say they understand the new prescription drug law very well and seven in 10 don’t know that it passed and was signed into law. Survey Toplines Chartpack News Release Statement by Drew Altman, President and CEO, Kaiser Family Foundation on the…

  • Benefit improvements for low-income Medicare beneficiaries

    Report

    Benefit Improvements for Low-Income Medicare Beneficiaries The Kaiser Family Foundation has prepared a summary showing how the House-passed Children’s Health and Medicare Protection (CHAMP) Act legislation would change current law regarding assistance for low-income Medicare beneficiaries. The summary describes proposed changes to current programs that provide assistance to low-income Medicare beneficiaries, including the Medicare Savings Program and the Medicare Part D Low-Income Subsidy (LIS) Program. The summary reviews how the CHAMP Act would modify each…

  • The Role of Health Coverage for People with Disabilities: Findings from 12 Focus Groups with People with Disabilities

    Report

    This report presents findings from focus groups conducted with people with a range of disabilities in an effort to understand the challenges they face and their experiences in the health-care system. To capture variations in experiences by source of health insurance, the groups include people covered under Medicare, Medicaid, and private insurance, as well as those no health insurance at all. The report highlights the ways in which various sources of insurance are working for…

  • Medicare-Medicaid Policy Interactions

    Issue Brief

    Because over seven million elderly and disabled individuals are entitled to benefits under both Medicare and Medicaid, policy changes in one program not only affect both coverage and spending in the other but also impact access to services by individuals eligible for both programs. This primer summarizes two key policy interactions and includes a quick reference table of the most significant linkages between the two programs. Issue Brief (.pdf)

  • The New Medicare Rx Benefit:  Challenges for Maintaining Access to Prescription Drugs

    Other Post

    The New Medicare Rx Benefit: Challenges for Maintaining Access to Prescription Drugs With the launch of the new Medicare Part D prescription drug benefit less than 18 months away, and growing interest in beneficiaries’ access to medications in the future, the Kaiser Family Foundation is pleased to release two new publications that examine issues concerning access to medications raised by the implementation of the new Part D Medicare prescription drug benefit. The New Medicare Drug…

  • The Medicare Prescription Drug Law – What Are Seniors Saying?

    Other Post

    As the first phase of the new Medicare prescription drug law takes effect, the Kaiser Family Foundation commissioned focus groups conducted by Bill McInturff of Public Opinion Strategies and Geoff Garin of Peter D. Hart Research Associates in consultation with Foundation staff. The focus groups were designed to explore what people on Medicare know and think about the discount drug card that went in effect June 1st, and the new benefit that takes effect in…