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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  • Can I receive extra benefits from a Medicare Advantage plan that I wouldn’t be able to get in traditional Medicare?

    FAQs

    Yes, Medicare Advantage plans can offer extra benefits that are not offered in traditional Medicare. For example, Medicare Advantage plans may offer dental coverage or a fitness benefit to those enrolled. Medicare Advantage plans can also offer benefits that are not directly health-related, like meal delivery services. Medicare Advantage plans may require an additional monthly premium for some of these supplemental benefits, such as dental coverage. Although Medicare Advantage plans can offer extra benefits, they…

  • Hay muchas opciones de la Parte de D de Medicare en mi área. ¿Cómo decidir cuál es el mejor plan para mí?

    FAQs

    Hay dos formas de obtener cobertura de medicamentos. Si tiene Medicare tradicional, puede inscribirse en un plan de medicamentos recetados independiente. O puede inscribirse en un plan Medicare Advantage que cubra todos sus beneficios de Medicare, incluido el de medicamentos recetados. Cualquiera que elija, sus costos y cobertura pueden variar de un plan a otro. Al elegir la cobertura de medicamentos que mejor se adapte a sus necesidades, puede comparar las primas de los planes,…

  • I am covered by Medicare, but I don’t take any medications. Do I need to sign up for a drug plan?

    FAQs

    Even if you aren’t taking any medications right now, it makes sense to enroll in a drug plan so that you have coverage in case your needs change in the future. If you don’t have coverage and the Medicare Open Enrollment period has ended, you won’t be able to sign up for coverage until the next Medicare Open Enrollment period begins, and your coverage wouldn’t take effect until January 1 of the following year. This…

  • There are a lot of Medicare Part D plan options in my area. How do I decide which plan is best for me?

    FAQs

    There are two ways you can get drug coverage. If you have traditional Medicare, you can sign up for a stand-alone prescription drug plan. Or you can join a Medicare Advantage plan that covers all your Medicare benefits including the prescription drug benefit. Whichever you choose, your costs and coverage can vary from one plan to another. In picking the drug coverage that best meets your needs, you can compare plan costs for the premium,…

  • I signed up for a stand-alone Part D plan early in the Medicare Open Enrollment period, but then I changed my mind. Can I switch to a different plan if the Medicare Open Enrollment period hasn’t ended?

    FAQs

    You can submit a new application for a plan other than the one to which you initially applied during the Medicare Open Enrollment period. Keep in mind that the last plan application you submit before the Medicare Open Enrollment period ends on December 7 is the coverage that will take effect on January 1 of the following year.

  • Can I be charged a higher premium for Medicare Part D plans if I have a pre-existing condition or if I smoke?

    FAQs

    No. Part D plan premiums are not allowed to vary depending on your age, health status, whether you have pre-existing conditions, or are a smoker. The monthly premium that any given Part D plan charges is the same for any beneficiary who chooses to enroll in that plan. If your income is over a certain level, you may be required to pay a higher premium. If you have a relatively low income and limited assets,…

  • I have drug coverage from the VA. Do I need to sign up for a Part D plan?

    FAQs

    No. Drug coverage from the VA (Veterans Affairs) is considered creditable prescription drug coverage, which means the coverage is at least as good as what Medicare drug plans provide, so you do not need to enroll in a Medicare Part D plan. Other sources of creditable drug coverage include the Federal Employee Health Benefits (FEHB) program, TRICARE (military health benefits), and Indian Health Services (IHS). People with creditable coverage should receive a notice from the…

  • What is Medigap?

    FAQs

    Medicare supplement insurance policies, or Medigap policies, help to pay the copayments, coinsurance, and deductibles for Medicare-covered benefits under traditional Medicare (Part A and Part B services). Some Medigap policies also cover services that traditional Medicare does not cover, such as medical care when you travel outside the country. Medigap policies do not work with Medicare Advantage plans and will not help to cover Medicare Advantage enrollees’ out-of-pocket costs.

  • I have a Medigap policy now, but I want to buy a different one. Can I switch Medigap policies during the Medicare Open Enrollment period?

    FAQs

    The annual Medicare Open Enrollment period is designed for enrolling in or switching Medicare Advantage and Part D prescription drug plans, not Medigap policies. In most states, insurance companies can deny you a different Medigap policy and you won’t have guaranteed issue rights, unless you are either eligible to switch under a certain limited circumstances or you purchased your Medigap policy less than 6 months ago. This means that in many situations, insurance companies that…