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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  • Faces of Dually Eligible Beneficiaries: Profiles of People with Medicare and Medicaid Coverage

    Issue Brief

    This brief examines the role of Medicare and Medicaid in the lives of dually eligible beneficiaries – low-income seniors and younger adults with disabilities who are eligible for both programs – through personal profiles. It includes a glossary of eligibility and service delivery system terms and state-level enrollment and expenditure data for dual eligibles.

  • Improving the Financial Accountability of Nursing Facilities

    Report

    This report examines nursing facility expenditures to assess relative spending increases in areas such as nursing services, administrative costs, and profits. Using California as a case study, it explores reimbursement by cost category and a standard medical loss ratio (MLR) as potential policy options to improve nursing facility financial accountability and care quality.

  • The Rising Cost of Living Longer: Analysis of Medicare Spending by Age for Beneficiaries in Traditional Medicare

    Report

    This analysis provides a detailed look at per person Medicare spending on the nearly 30 million beneficiaries over age 65 who are enrolled in the traditional Medicare program. Among the key findings of the report is that per person spending rises with age, peaking at age 96. But this rise is not entirely explained by Medicare spending on end of life care, which declines with age. What Medicare spends money on also changes as beneficiaries…

  • Long-Term Care in the United States: A Timeline

    Other Post

    Long-term care (LTC) in the United States has evolved over the course of the last century to better serve the needs of seniors and person with disabilities. This long-term care timeline outlines the major milestones in LTC from the nursing home era, which created an institutional bias in LTC, to the era of home and community based services (HCBS) and integration, and into the era of health reform and beyond.

  • The Latest on Geographic Variation in Medicare Spending: A Demographic Divide Persists But Variation Has Narrowed

    Report

    This report uses the most current data available to analyze Medicare per beneficiary spending, by county, in 2013; the growth in Medicare per beneficiary spending between 2007 and 2013, by county; and the extent to which geographic variation in Medicare per beneficiary spending has increased or decreased over time. The analysis finds that beneficiaries living in counties with relatively high Medicare per beneficiary spending tend to be sicker and poorer than beneficiaries living in lower-spending…

  • A Study of Medicare Advantage Plan Networks in 20 Counties Finds That Plans Include About Half of All Hospitals in Their Area 

    News Release

    A Kaiser Family Foundation analysis of private Medicare plan networks finds that Medicare Advantage plans include about  half of area hospitals in their network, on average, while one in five plans have no  Academic Medical Center in-network.  Among plans in an area with a National Cancer Institute-designated cancer center, more than two in five did not include the cancer center in their network. The new study of the hospital networks of Medicare Advantage plans, which…

  • Independent Payment Advisory Board (IPAB) Process: A Timeline

    Feature

    IPAB Timeline Download Source Kaiser Family Foundation, “The Independent Payment Advisory Board: A New Approach to Controlling Medicare Spending,” 2011, https://www.kff.org/health-reform/issue-brief/the-independent-payment-advisory-board-a-new/.