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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.

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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  • Do People Who Sign Up for Medicare Advantage Plans Have Lower Medicare Spending?

    Issue Brief

    The analysis finds that people who switched from traditional Medicare to Medicare Advantage in 2016 had health spending in 2015 that was $1,253 less, on average, than the average spending for beneficiaries who remained in traditional Medicare (after adjusting for health risk). The findings suggest that the current payment method may systematically overestimate expected costs of Medicare Advantage enrollees. Adjusting payments to reflect Medicare Advantage enrollees’ prior use of health services could potentially lower total…

  • Beneficiaries Who Switch to Medicare Advantage Have Lower Medicare Spending and Use Fewer Services – In the Prior Year – Than Those Who Stay in Traditional Medicare

    News Release

    Medicare Advantage plans gain beneficiaries from traditional Medicare who have lower average spending and use fewer health services than similar beneficiaries who choose to remain in traditional Medicare, according to a new KFF analysis. The analysis finds that people who switched from traditional Medicare to Medicare Advantage in 2016 had health spending in 2015 that was $1,253 less, on average, than the average spending for beneficiaries who remained in traditional Medicare (after adjusting for health…

  • New Analysis Compares Prescription Drug Spending and Use Across Large Employer Plans, Medicare, and Medicaid

    News Release

    As policymakers debate how to address the high cost of prescription drugs, a new KFF analysis compares data on prescription drug spending and use across large employer plans, Medicare Part D and Medicaid, and provides context for policy discussions about different approaches to curb rising drug costs that would affect people covered by each of the three major payers. The data show that private insurers, Medicare and Medicaid account for 82 percent of retail prescription…

  • Brief Examines Five Potential Ways to Improve Dental Coverage for People on Medicare

    News Release

    Medicare does not cover routine dental care, and two-thirds of the Medicare population have no dental coverage at all. With limited or no dental coverage, some incur high out-of-pocket costs, while others forgo need dental care because they can’t afford it. Policymakers in Washington and others are exploring ways to make dental care more affordable for the 60 million people on Medicare. A new KFF brief examines five potential ways to make oral health care…

  • Visualizing Health Policy: Medicare Spending: A Look at Present, Short-Term and Long-Term Trends

    Other Post

    This Visualizing Health Policy infographic with the Journal of the American Medical Association (JAMA) provides an overview of Medicare spending trends in the present, short term and long term. In the long term, Medicare spending as a share of the economy is projected to grow, and Medicare is projected to lack sufficient funds to pay all hospital bills beginning in 2030.

  • Health Affairs Article: At Least Half of New Medicare Advantage Enrollees Had Switched From Traditional Medicare During 2006-11

    Issue Brief

    In an article in Health Affairs, researchers from the Kaiser Family Foundation counter the popular misperception that the steady rise in Medicare Advantage enrollment has been driven by members of the Baby Boom generation overwhelmingly choosing the private plans as they become eligible for Medicare. Their study examines the 2006-2011 growth in Medicare Advantage enrollment and finds that a majority of new enrollees in Medicare Advantage in each year were, in fact, seniors switching from…

  • New Report on the “Rising Cost of Living Longer” Details Medicare Spending by Age

    News Release

    A new report, The Rising Cost of Living Longer: Analysis of Medicare Spending by Age for Beneficiaries in Traditional Medicare, from the Kaiser Family Foundation takes a detailed look at per person Medicare spending by age and by service among the nearly 30 million people covered by traditional Medicare in 2011

  • Summary of Medicare Provisions in the President’s Budget for Fiscal Year 2016

    Issue Brief

    On February 2, 2015, the Office of Management and Budget released President Obama’s budget for fiscal year (FY) 2016, which includes provisions related to federal spending and revenues, including Medicare savings. The President’s FY2016 budget proposal would reduce net Medicare spending by $423 billion between 2016 and 2025, and is estimated to extend the solvency of the Medicare Hospital Insurance Trust Fund by approximately five years. This brief summarizes the Medicare provisions included in the…