Medicare

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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.

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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  • Key Facts About Medicare Part D Enrollment and Costs in 2023

    Issue Brief

    The Medicare Part D program provides an outpatient prescription drug benefit to older adults and people with long-term disabilities in Medicare who enroll in private plans. This brief analyzes Medicare Part D enrollment and costs in 2023 and trends over time. The analysis highlights the substantial growth of Medicare Advantage drug plans in the marketplace for Part D drug coverage, where enrollment overall is concentrated in a handful of large plan sponsors.

  • Medicare Advantage Insurers Report Much Higher Gross Margins Per Enrollee Than Insurers in Other Markets

    News Release

    A new analysis of health insurers’ 2021 financial data shows that insurers continue to report much higher gross margins per enrollee in the Medicare Advantage market than in other health insurance markets. The analysis examines insurers’ financial data in the Medicare Advantage, Medicaid managed care, individual (non-group), and fully insured group (employer) markets. In 2021, Medicare Advantage insurers reported gross margins averaging $1,730 per enrollee, at least double the margins reported by insurers in the…

  • As Debate Heats Up in Washington Over Possible Entitlement Cuts, A New KFF Analysis Details the 30% of Federal Spending That Goes to Health Care Programs

    News Release

    As some policymakers in Washington are pushing to reduce the federal deficit and debt, a new KFF resource provides a concise explanation of federal spending for domestic and global health programs and services, which could be part of any conversation about curbing federal spending. Federal spending on health programs and services accounted for 30 percent of net federal spending in fiscal year 2022 -- or $1.7 trillion out of a total of $5.9 trillion. Specifically,…

  • What Could New Anti-Obesity Drugs Mean for Medicare?

    Policy Watch

    In this piece, we discuss Medicare coverage of obesity treatments, the potential cost implications if Medicare covers anti-obesity drugs, and how the Inflation Reduction Act could potentially address these cost concerns.

  • Medicare and People with HIV

    Issue Brief

    This data note provides an overview of the role of the Medicare program for people with and at risk for HIV.

  • Tengo una póliza Medigap, pero quiero comprar una diferente. ¿Puedo cambiarla por otra Medigap durante el Período de Inscripción Abierta de Medicare?

    FAQs

    El Período de Inscripción Abierta anual de Medicare está diseñado para inscribirse o cambiar los planes de medicamentos recetados de Medicare Advantage y la Parte D, no para las pólizas de Medigap. En la mayoría de los estados, las compañías de seguros pueden negarle una póliza Medigap diferente y no tendrá ese derecho garantizado, a menos que sea elegible para cambiarla bajo un número limitado de circunstancias o haya comprado su póliza Medigap hace menos…

  • Traditional Medicare…Disadvantaged?

    Perspective

    In this new policy insight, Tricia Neuman examines current rules that may discourage seniors from switching from Medicare Advantage to traditional Medicare. The issue is explored through the lens of a 67-year-old beneficiary who faced difficult financial and health coverage choices in the aftermath of a serious biking accident.