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.

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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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  • Consumer Protection Issues Raised by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003

    Report

    This paper identifies and examines consumer protection issues that arise from the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Key issue areas include: beneficiary information, marketing, enrollment and disenrollment, the drug benefit package and cost-sharing, the appeals process, concerns for low-income beneficiaries, challenges for nursing home issues, and fraud and abuse. Report (.pdf)

  • Medicare Drug Discount Cards: A Work In Progress (Briefing)

    Other Post

    Medicare Drug Discount Cards: A Work In Progress This report examines the early experience with the Medicare-Approved Drug Discount Card Program, prices offered by card sponsors, and potential savings for enrollees. The report presents information about approved discount card programs, including sponsors, enrollment fees, and drugs covered, as well as beneficiary education and outreach efforts by the Centers for Medicare & Medicaid Services. The pricing analysis shows that discount cards can deliver savings off of…

  • Current Trends and Future Outlook for Retiree Health Benefits:  Findings from the Kaiser/Hewitt 2004 Survey on Retiree Health Benefits

    Other Post

    Current Trends and Future Outlook for Retiree Health Benefits: Findings from the Kaiser/Hewitt 2004 Survey on Retiree Health Benefits A new survey of large employers finds businesses and retirees experienced double-digit increase in retiree health costs, with further increases expected in 2005. The survey also includes an early look at employers' responses to the new Medicare drug law. News Release Report - Interactive online version and downloadable chapters Chartpack Materials From the December 14, 2004…

  • Medicare Part D 2009 Data Spotlight: The Coverage Gap

    Report

    This Medicare Part D data spotlight examines the coverage gap, or "doughnut hole," in Medicare drug plans available in 2009. While in the gap in coverage, Part D enrollees (other than those receiving low-income subsidies) are required to pay 100 percent of total drug costs until they reach the catastrophic coverage level. In 2009, nearly all Part D plans have a coverage gap, though one in four plans offer limited coverage in the gap --…

  • Medicare Advantage 2012 Data Spotlight: Enrollment Market Update

    Report

    This data spotlight examines the growth in private Medicare Advantage plan enrollment in 2012, with a record 13 million Medicare beneficiaries enrolled as of March, representing 27 percent of all Medicare beneficiaries. Enrollment jumped by more than 1 million enrollees from the previous year and increased in every state except Alaska and New Hampshire. Medicare Advantage plan enrollees generally must pay Medicare's standard Part B premium, but more than half do not pay any additional…

  • The Exceptions and Appeals Process: Issues and Concerns in Obtaining Coverage Under the Medicare Part D Prescription Drug Benefit

    Issue Brief

    This issue brief describes how Medicare beneficiaries navigate the Medicare Part D exceptions, appeals, and grievances processes to get access to medically necessary prescriptions not covered under their Medicare prescription drug plans. It identifies and describes policy issues that may make it difficult for beneficiaries to utilize the processes. Issue Brief (.pdf)

  • Prospects for Retiree Health Benefits as Medicare Drug Coverage Begins – Report

    Report

    Prospects for Retiree Health Benefits as Medicare Drug Coverage Begins:Findings from the Kaiser/Hewitt 2005 Survey on Retiree Health Benefits - Report This report assesses how large businesses that provide retiree health benefits to their workers are responding to the new Medicare drug benefit in 2006, their plans for the future, and the way these responses affect retirees. It also looks at the rising costs and changing benefits of retiree health coverage overall in 2005. Full…

  • Medicare and Medicaid for the Elderly and Disabled Poor

    Other Post

    This fact sheet provides an overview of the role of Medicare and Medicaid in serving these beneficiaries; describes the health status of dual Medicare/Medicaid beneficiaries, and discusses issues of managed care and access to care. Available in PDF format. Return to top Library Index

  • Special Needs Plans: Availability and Enrollment

    Report

    Special Needs Plans are a form of Medicare Advantage plan authorized to provide a managed care option for beneficiaries with significant or relatively specialized care needs, including Medicare beneficiaries who are dually eligible for Medicare and Medicaid, beneficiaries living in nursing homes or other institutions, and beneficiaries with severe chronic or disabling conditions. This data spotlight examines availability and enrollment trends for Special Needs Plans, which account for a small share of enrollment today but…