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.

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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  • 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,…

  • 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 Medigap and I’m finding it difficult to afford. What are my other options for supplemental coverage?

    FAQs

    You may want to find out if you qualify for Medicaid, if your income and assets are low enough. Medicaid helps many low-income people on Medicare with their Medicare premiums and cost-sharing requirements, and may also cover some benefits that are not covered by Medicare, such as dental services and long-term services and supports. To find out if you qualify, you can contact the State Medical Assistance Office or the State Health Insurance Assistance Program…

  • I am 66 years old, work for a large employer, and have health insurance coverage through my job. I am planning to keep working for a few more years and keep the coverage that my employer offers. What ar...

    FAQs

    When you stop working and/or your group health insurance coverage ends, you should enroll in Medicare Part A and Part B. If you’re eligible for premium-free Part A, you can sign up any time after you’re first eligible for Medicare. Your Part A coverage will go back retroactively 6 months from when you sign up (but no earlier than the first month you were eligible). You have an 8-month Special Enrollment Period (SEP) to enroll…

  • If my employer offers retiree health benefits, do I need to sign up for Medicare when I turn 65?

    FAQs

    For most people with retiree health benefits, it makes sense to sign up for Medicare when you are first eligible to do so. Retiree health plans are typically designed to supplement Medicare, and might not pay your medical costs during any period that you were eligible for Medicare but not signed up for it. You should review any information provided by your employer to be sure you understand how your retiree health benefits coordinate with…

  • I am about to turn 65; my spouse is 60 and still working. We are both covered under her employer’s health plan. Do I have to do anything with regard to Medicare this year?

    FAQs

    A person (or a person’s spouse) with group health coverage through a current employer may be able to delay enrolling in Part A and Part B until that coverage ends, and won’t face penalties for enrolling later, but only if the employer has 20 or more employees. If your wife’s employer has at least 20 employees, you may want to enroll in Part A (if you qualify for premium-free Part A) but delay enrollment in…

  • I’m under 65 and have a long-term disability. I am no longer working and receiving Social Security disability benefits. Am I eligible for Medicare?

    FAQs

    It depends on how long you have been receiving Social Security disability insurance (SSDI) payments. You are automatically enrolled in Medicare Part A and Part B after you have been receiving SSDI payments for two years. However, people with disabilities who have Amyotrophic Lateral Sclerosis (ALS) do not have to wait two years and are eligible for Medicare immediately upon collecting SSDI, and people with end-stage renal disease (ESRD) are eligible for Medicare three months…

  • What is a Medicare Accountable Care Organization? Can I enroll in one when I sign up for Medicare or during the Medicare Open Enrollment period?

    FAQs

    Medicare Accountable Care Organization (ACOs) are groups of doctors, hospitals, and other health care providers who voluntarily form partnerships to have collective responsibility for the quality and total cost of care delivered to their patients. ACOs are not health plans and you cannot “enroll” in them. Medicare may assign you to an ACO if your primary care doctor is in one, but you are still free to seek services from any Medicare provider inside or…

  • How can I find out if my doctor accepts Medicare?

    FAQs

    Most doctors in the United States accept Medicare. To find a list of doctors in your area who accept Medicare and agree not to bill you for more than the approved Medicare amount for your visit or procedure, go to Medicare’s Care Compare website , select “Doctors & clinicians” under the Provider Type dropdown menu, and look for providers noted as charging the Medicare-approved amount. If you do not have access to a computer, you…

  • I want to switch from Medicare Advantage to traditional Medicare, but I still want drug coverage. What do I need to do?

    FAQs

    If you switch from a Medicare Advantage plan to traditional Medicare and you want drug coverage, you can sign up during the Medicare Open Enrollment period for a stand-alone prescription drug plan in your area. Your new coverage will take effect on January 1. You can also switch from Medicare Advantage to traditional Medicare during the Medicare Advantage Open Enrollment period between January 1 and March 31, when you can sign up for a stand-alone…