Medicare

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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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  • Policy Insight Examines How Current Rules May Deter Seniors From Switching from Medicare Advantage to Traditional Medicare and Implications for Medicare’s Future

    News Release

    In this new policy insight, the Kaiser Family Foundation’s Tricia Neuman examines current rules that may discourage seniors from switching from Medicare Advantage to traditional Medicare.Traditional Medicare…Disadvantaged? explores this issue through the lens of a 67-year old Boomer who faced difficult financial and health coverage choices in the aftermath of a serious mountain biking accident. Previous columns in the Policy Insights series are also available.

  • Visualizing Health Policy: Recent Trends in Prescription Drug Costs

    News Release

    This Visualizing Health Policy infographic spotlights national spending on prescription drugs and the public’s views on pharmaceutical prices. Prescription drug spending rose sharply in 2014, driven by growth in expenditures on specialty drugs, including medications to treat cancer and hepatitis C. Medicare’s spending on prescription pharmaceuticals also has risen, largely due to the addition of the Medicare prescription drug benefit in 2006: between 2004 and 2014, the program’s share of US drug expenditures increased from…

  • Medicare Payment System Reforms: What Do We Know?

    Event Date:
    Event

    Medicare is testing new ways to pay for medical services, emphasizing value rather than volume, and evidence is beginning to build about successes and challenges. On Monday, April 11, the Kaiser Family Foundation (KFF) and the Alliance for Health Reform will host a briefing to examine what we know so far about the basic models, savings, quality, the impact on patients and the prospects for replication. Moderated by KFF’s Tricia Neuman and the Alliance’s Marilyn Serafini, Monday's discussion will…

  • Medicare Part D 2009 Data Spotlight: Specialty Tiers

    Issue Brief

    Most Medicare Part D prescription drug plans use tiers with different cost-sharing amounts for generic, preferred, and non-preferred drugs, and also include an additional “specialty” tier for very high cost and unique drugs. This 2009 Part D Data Spotlight examines use of the specialty tier, including the numbers and kinds of drugs included on specialty tiers, what beneficiaries pay for those drugs, and trends over time. The spotlight is one in a series analyzing key…

  • Strategies for Simplifying the Medicare Advantage Market

    Other Post

    Most Medicare beneficiaries have at least 40 Medicare Advantage (MA) plan options to choose from this year. While some favor a robust marketplace, others argue that fewer plan offerings, or more transparent differences across plans designs, would help beneficiaries choose plans most likely to meet their individual needs. While consumers generally show interest in choice and economists see it as enhancing value, research shows that individuals faced with a large number of alternatives often avoid…

  • Explaining Health Reform: Medicare and the New Independent Payment Advisory Board

    Issue Brief

    This brief describes how the new board created under the 2010 health reform law is expected to limit the growth in Medicare spending over time. Starting in 2014, if projected per capita Medicare spending exceeds targets set in the law, the board must recommend ways to reduce Medicare spending, while maintaining quality and access to care for beneficiaries. The board’s recommendations automatically take effect the next year unless Congress adopts an alternative plan to achieve…

  • Medicare Part D 2010 Data Spotlight: Premiums

    Report

    Medicare Part D helps cover the cost of outpatient prescription drugs for 27 million beneficiaries enrolled in private stand-alone prescription drug plans (PDPs) and Medicare Advantage prescription drug (MA-PD) plans. The majority of Part D enrollees pay a monthly premium for Medicare drug coverage. This data spotlight examines premiums for enrolling in Medicare's PDPs in 2010 and trends since 2006.  The spotlight is one in a series analyzing key aspects of the Medicare Part D…

  • Raising Medicare Premiums for Higher-Income Beneficiaries: Assessing the Implications

    Issue Brief

    As policymakers consider ways to slow the growth in Medicare spending as part of broader efforts to reduce the federal debt or offset the cost of other spending priorities, some have proposed to increase beneficiary contributions through higher Medicare premiums. This issue brief explains provisions of current law that impose income-related premiums under Medicare Part B and Part D, describes recent proposals to modify these requirements, and analyzes the potential implications for the Medicare population.

  • Key Issues in Understanding the Economic and Health Security of Current and Future Generations of Seniors

    Issue Brief

    As part of broad deficit-reduction plans, policymakers are considering reforms to the nation's three major entitlement programs - Medicare, Medicaid and Social Security - that could significantly affect the economic security of seniors in their retirement years. This brief examines the role of these programs in ensuring seniors' financial security as well as the challenges facing current and future generations when it comes to economic and health security. Drawing from current research and data, the…

  • Among Dual Eligibles, Identifying The Highest Cost Individuals Could Help In Crafting More Targeted And Effective Responses

    Report

    This Health Affairs article by researchers at the Urban Institute analyzes linked Medicare and Medicaid data to examine dual eligibles' utilization and spending in both programs in 2007. It finds that while the population of people dually eligible for Medicare and Medicaid is indeed costly, it is not monolithic. For instance, although 20 percent of dual eligibles accounted for more than 60 percent of combined Medicaid and Medicare spending, nearly 40 percent of dual eligibles…