Medicare

NEW AND NOTEWORTHY

What to Know About Medicare Coverage of Telehealth

Congress has repeatedly extended pandemic-era flexibilities around Medicare coverage of telehealth, but most such flexibilities remain temporary. This brief answers key questions about the current scope of Medicare telehealth coverage, including both temporary and permanent changes adopted through legislation and regulation, and future policy considerations.

Examining the Potential Impact of Medicare’s New WISeR Model

A federal initiative to establish new prior authorization requirements in traditional Medicare, called the Wasteful and Inappropriate Service Reduction (WISeR) model, is likely to have only modest impact in its first year.

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. u003cbru003eu003cbru003eExplore 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.u003cbru003eu003cbru003eu003ca href=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022 data-type=u0022linku0022 data-id=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022u003eRelated:u003ca href=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022u003e FAQs on Medicare Financing and Trust Fund Solvencyu003c/au003eu003c/au003e

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  • KFF Analysis: Number of Coronavirus Cases, Distribution of $30B in CARES Act funding and Medicare Advantage Penetration by State

    Fact Sheet

    Number of Coronavirus Cases, Distribution of $30B in CARES Act funding and Medicare Advantage Penetration by StateStateNumber ofCOVID-19 Cases on April 21, 2020Percent of Total COVID-19 CasesFirst Distribution of CARES Act PaymentsPercent of Total Money DistributedPercent of Medicare Beneficiaries in Medicare Advantage, 2020New York253,400.0032.1%$1,859,574,4346.2%40%New Jersey88,806.0011.3%$919,426,8013.1%29%Massachusetts39,643.005.0%$841,425,1202.8%23%Pennsylvania34,005.004.3%$1,246,250,0764.2%41%California33,866.004.3%$2,920,960,7339.7%40%Michigan32,000.004.1%$936,700,1393.1%42%Illinois31,508.004.0%$1,204,103,1804.0%25%Florida27,058.003.4%$2,220,563,1377.4%43%Louisiana24,523.003.1%$474,891,7351.6%38%Connecticut19,815.002.5%$377,981,2571.3%41%Texas20,087.002.5%$2,089,066,4527.0%37%Georgia19,398.002.5%$792,069,1602.6%37%Maryland14,193.001.8%$742,225,3062.5%11%Ohio12,919.001.6%$989,773,4173.3%39%Washington12,486.001.6%$553,838,8061.8%33%Indiana11,688.001.5%$668,604,6142.2%32%Colorado10,112.001.3%$360,905,4821.2%38%Virginia9,097.001.2%$814,360,4672.7%21%Tennessee7,238.000.9%$739,723,3472.5%38%North Carolina6,979.000.9%$919,171,0873.1%36%Missouri5,963.000.8%$618,601,1672.1%35%Rhode Island5,090.000.6%$90,459,8340.3%39%Arizona5,068.000.6%$707,587,4822.4%39%Alabama5,092.000.6%$449,481,9451.5%41%Mississippi4,512.000.6%$374,847,7901.2%20%Wisconsin4,541.000.6%$471,681,0771.6%42%South Carolina4,439.000.6%$518,022,4631.7%28%Nevada3,830.000.5%$241,471,8410.8%36%Utah3,213.000.4%$185,292,4220.6%36%Iowa3,159.000.4%$297,929,1711.0%22%Kentucky3,050.000.4%$452,761,1711.5%34%District of Columbia3,098.000.4%$84,989,0990.3%20%Delaware2,745.000.3%$154,114,1180.5%17%Oklahoma2,680.000.3%$489,853,9981.6%22%Minnesota2,470.000.3%$472,206,1221.6%43%Kansas2,070.000.3%$325,135,9501.1%19%Oregon1,956.000.2%$291,029,0251.0%42%Arkansas1,990.000.3%$326,536,0431.1%26%New Mexico1,971.000.2%$169,486,1320.6%35%South Dakota1,685.000.2%$107,650,2010.4%19%Idaho1,736.000.2%$135,028,0560.5%33%Nebraska1,648.000.2%$225,027,9120.8%17%New Hampshire1,447.000.2%$164,580,3860.5%19%Puerto Rico1,298.000.2%$41,889,8220.1%70%West Virginia908.000.1%$246,574,8510.8%31%Maine875.000.1%$145,763,8120.5%36%Vermont816.000.1%$54,457,8700.2%12%North Dakota627.000.1%$91,064,5790.3%17%Hawaii584.000.1%$132,536,0760.4%44%Montana433.000.1%$111,503,2480.4%18%Alaska321.000.0%$71,248,1230.2%1%Wyoming429.000.1%$66,393,1630.2%3%NOTES: COVID-19 data as of 4/21/2020 at 10:38 AM.SOURCES: Johns Hopkins University, [Coronavirus COVID-19 Global Cases by the Center for…

  • I am age 60 and have been receiving Social Security disability insurance (SSDI) payments for two years. My Medicare coverage just started and I would like to get a Medicare supplement insurance policy....

    FAQs

    It depends on the state where you live. Some states require insurance companies to sell Medigap supplement policies to people under age 65, but not all states do. Insurance companies may still voluntarily sell Medigap policies to people under age 65, even in states that do not require insurance companies to sell Medigap policies to people under age 65. However, premiums may be much higher than premiums for people ages 65 and older. If you…

  • Is the Medicare Open Enrollment period the same as the Marketplace Open Enrollment period? Can I buy Medicare and Medigap plans through the Marketplace?

    FAQs

    There is some overlap in the enrollment periods for Medicare and the Marketplaces, but they are not the same. The Medicare Open Enrollment period runs from October 15 through December 7 each year. For Marketplace coverage in 2026, the open enrollment period will run from November 1, 2025 through January 15, 2026 in states that use the Healthcare.gov website; states that run their own marketplaces may have a longer open enrollment period for 2026. If…

  • I’m receiving extra help with my Part D plan premium and cost sharing through the Low-income Subsidy Program. I received a notice that my current plan will no longer be offered next year. Now what do I do?

    FAQs

    If you qualify for the full premium subsidy for your Medicare prescription drug plan, are enrolled in traditional Medicare, and your current prescription drug plan will not be offered next year, you will be automatically reassigned by Medicare to a new prescription drug plan for coverage in the next year. But you won’t be reassigned automatically if your current plan is terminating and you chose your current plan. In that case, you will have to…

  • Can I be charged a higher premium for a Medigap policy if I have a pre-existing condition or if I smoke?

    FAQs

    It depends. If you are applying for a Medigap policy during your initial Medicare enrollment period, then regardless of your past or current health problems, you are guaranteed the right to purchase any Medigap policy at the same premium the offering company charges other people your age. Some policies may make you wait up to six months before covering a pre-existing condition, and some may offer “discounts” for non-smokers. If you are applying for a…

  • Can I get information about Medigap policies on the Medicare coverage comparison website, or use the website to sign up for a Medigap policy?

    FAQs

    You can find some information about Medigap policies on the Medicare coverage comparison website, by going to the link to “Find a Medicare Supplement Insurance (Medigap) policy” under the Health & Drug Plans: Find & Compare menu. This tool produces a list of companies in your area that offer each type of Medigap plan, although you can’t enroll directly in a Medigap policy on this website. You will need to contact the insurance companies directly…

  • I have a Medigap policy now, but I want to buy a different one. Can I switch Medigap policies during the Medicare Open Enrollment period?

    FAQs

    The annual Medicare Open Enrollment period is designed for enrolling in or switching Medicare Advantage and Part D prescription drug plans, not Medigap policies. In most states, insurance companies can deny you a different Medigap policy and you won’t have guaranteed issue rights, unless you are either eligible to switch under a certain limited circumstances or you purchased your Medigap policy less than 6 months ago. This means that in many situations, insurance companies that…

  • I have drug coverage from the VA. Do I need to sign up for a Part D plan?

    FAQs

    No. Drug coverage from the VA (Veterans Affairs) is considered creditable prescription drug coverage, which means the coverage is at least as good as what Medicare drug plans provide, so you do not need to enroll in a Medicare Part D plan. Other sources of creditable drug coverage include the Federal Employee Health Benefits (FEHB) program, TRICARE (military health benefits), and Indian Health Services (IHS). People with creditable coverage should receive a notice from the…