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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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  • Medicare’s Coverage Decision for the New Alzheimer’s Drug and Why It Matters

    Policy Watch

    This policy watch discusses the implications of Medicare's preliminary National Coverage Determination for the new Alzheimer's drug, Aduhelm, on the 2022 Medicare Part B premium and the possibility of an adjustment based on the coverage decision. The piece also discusses the implications for Medicare spending and the connection to ongoing policy discussions around prescription drug proposals in the Build Back Better Act.

  • Simulating the Impact of the Drug Price Negotiation Proposal in the Build Back Better Act

    Issue Brief

    The Build Back Better Act (BBBA) includes a range of health and other proposals supported by President Biden, including a proposal to allow the federal government to negotiate the price of some prescription drugs covered under Medicare Part B (administered by physicians) and Medicare Part D (retail outpatient drugs). This brief illustrates the potential scope of the drug price negotiation proposal in the BBBA. This analysis is designed to highlight the types of Medicare-covered drugs…

  • Millions of Medicare Beneficiaries Use Prescription Drugs That Could Be Subject to Price Negotiation, But Build Back Better Act Provision Exempts Many Drugs With High Federal Spending

    News Release

    Twenty drugs and dozens of insulin products used by 8.5 million Medicare beneficiaries would be subject to government drug price negotiation if the Build Back Better Act (BBBA) were enacted and fully implemented in 2022, according to a new KFF analysis. The 20 drugs include 18 drugs available to beneficiaries covered under Medicare Part D (typically drugs purchased at the pharmacy) and two drugs covered under Medicare Part B (physician-administered drugs). The list includes drugs…

  • Are Medicare Advantage Insurers Covering the Cost of At-Home COVID-19 Tests?

    Policy Watch

    The Biden Administration's requirement for private insurers to cover the cost of at-home rapid COVID-19 tests for their enrollees does not apply to Medicare. Medicare Advantage plans (offered by private insurers) have the option to cover at-home tests but are not required to do so. This policy watch examines whether some of the largest private Medicare Advantage plans are covering the cost of at-home rapid tests for COVID-19.

  • Analysis Finds The Share of Nursing Home Staff Who Have Been Vaccinated Against COVID-19 Varies Substantially by State

    News Release

    The share of nursing home staffers who have been fully vaccinated against COVID-19 varies considerably by state, from 70 percent in Ohio to 99 percent in Maine, Rhode Island, New York and Massachusetts, a new KFF analysis finds. The national average is 84 percent. The analysis of federal nursing home data for the week ending Jan. 30 comes as providers strive to comply with a federal mandate that health care workers whose employers participate in…

  • Medicare Part B Drugs: Cost Implications for Beneficiaries in Traditional Medicare and Medicare Advantage

    Issue Brief

    In the face of rising prescription drug costs, a large majority of the public supports federal efforts to lower drug spending. Policymakers are considering several proposals that would lower prescription drug costs. To better understand the potential out-of-pocket cost exposure that Medicare beneficiaries may face for Part B drugs, which are typically administered by physicians and other health care providers, we analyzed cost-sharing liability for these drugs in traditional Medicare and cost-sharing requirements in Medicare…

  • The Growth in Share of Medicare Advantage Spending

    Feature

    Earlier this week, the Biden Administration announced the final Medicare Advantage rates for 2023, which are projected to result in an average increase in Medicare Advantage plan revenue of 8.5% compared to 2022 - the highest average expected increase in recent years. Payments to Medicare Advantage plans as a share of total Medicare spending on Part A and Part B services have increased from 26% in 2010 to 45% in 2020, and are expected to…

  • Medicare Advantage in 2021: Star Ratings and Bonuses

    Issue Brief

    In 2021, 81 percent of all Medicare Advantage enrollees are in plans that receive a bonus payment from Medicare based on star quality ratings (or because they are new), substantially higher than the share in 2015 (55 percent). Annual bonus payments from the federal government to Medicare Advantage insurers have increased correspondingly, quadrupling from $3 billion in 2015 to $11.6 billion in 2021.

  • Why Drug Price Negotiation Has Staying Power

    From Drew Altman

    In this Axios column, Drew Altman looks beyond Medicare to what’s at stake for employers and workers in the debate about the government negotiating drug prices.