Medicare

New & Noteworthy

What to Know About Pharmacy Benefit Managers and Federal Efforts at Regulation

The top three pharmacy benefit managers (PBMs) manage 79% of prescription drug claims on behalf of 270 million people. We look at the role PBMs play in influencing drug costs and access to medicines, as well as efforts to regulate them.

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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  • Turning Medicare Into a Premium Support System: Frequently Asked Questions

    Issue Brief

    Premium support is a general term used to describe an approach to reform Medicare that aims to reduce the growth in Medicare spending. These FAQs raise and discuss basic questions about the possible effects of a premium support system for Medicare beneficiaries, the federal budget, health care providers, and private health plans.

  • Medicare’s Role for People Under Age 65 with Disabilities

    Issue Brief

    This issue brief examines the role of Medicare for people under age 65 with disabilities, including how this group qualifies for Medicare, the characteristics of people under age 65 with disabilities compared to those age 65 or older, and how sources of supplemental coverage and prescription drug coverage, spending and use of services, and access to care differ for Medicare beneficiaries under age 65 with disabilities and older beneficiaries.

  • Medicare Part D in 2016 and Trends over Time

    Report

    This chartpack presents a summary of Part D enrollment, premiums, cost sharing, benefit design and other key trends in 2016 and changes over time. For 2016, the analysis finds that 40% of Part D enrollees are now in Medicare Advantage drug plans, and over half of all enrollees are in plans offered by just three firms. The chartpack also highlights some concerning trends in the Low-Income Subsidy market, with the fewest number of premium-free plans available since Part D started, and 1.5 million LIS enrollees paying premiums for coverage, even though they have premium-free options available.

  • Voters Aren’t Buying Trump’s Promises of a Health Care Plan

    From Drew Altman

    Drew Altman showcases new KFF polling on the public’s views of President Trump’s promise that he will have a “phenomenal” health care plan and protect Medicare, and analyzes what it means for health care politics.

  • Examining Medicare Part D Policies for Extended Supplies of Medication

    Issue Brief

    Medicare Part D plan sponsors, which provide drug coverage to 45 million older adults and people with disabilities, have the option to relax their ‘refill too soon’ restrictions in response to the COVID-19 pandemic, as part of efforts to ensure adequate access to medications in disasters or emergencies. This analysis examines the share of Part D enrollees who currently have access to extended supplies of generic, brand-name, and specialty-tier drugs covered by their plan in 2020, prior to relaxation of any early-fill restrictions in response to the COVID-19 outbreak.

  • Problems Getting Care Due to Cost or Paying Medical Bills Among Medicare Beneficiaries

    Issue Brief

    There is ongoing discussion as to whether Congress should waive COVID-19 treatment costs. To inform these discussions, this analysis examines the extent of health care cost-related problems among Medicare beneficiaries. The analysis is based on a composite measure of cost-related burdens that includes problems getting care due to cost, delays seeking care due to cost, and problems paying medical bills among people with Medicare.

  • Medicare Advantage 2020 Spotlight: First Look

    Issue Brief

    In 2020, more than 22 million Medicare beneficiaries (34%) are enrolled in Medicare Advantage plans, which are mainly HMOs and PPOs offered by private insurers as an alternative to the traditional Medicare program. This data note provides an overview of the Medicare Advantage plans that will be available in 2020, including the variation in the number of plans available by county and plan type. The brief also examines the insurers entering the Medicare Advantage market for the first time and also examines the insurers exiting the market.