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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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  • Private Plans In Medicare: A 2007 Update

    Issue Brief

    This March 2007 issue brief, commissioned by the Kaiser Family Foundation, examines changes between 2006 and 2007 in the availability of and enrollment in Medicare Advantage and Medicare prescription drug plans overall and in urban and rural areas. It also focuses on the firms that are offering various types of Medicare plans. Marsha Gold of Mathematica Policy Research, Inc., prepared the brief. Issue Brief (.pdf)

  • The Basics of Medicare and Medicaid

    Issue Brief

    Together, Medicare and Medicaid provide health coverage to about 90 million Americans. To help explain the two programs, the Kaiser Family Foundation issued a new primer on the Medicare program and an updated version of its primer on the Medicaid program. Prepared by Kaiser staff, the primers provide an overview of the programs, who they serve, how the programs work and how they are financed. Medicare: A Primer Medicaid: A Primer

  • Medicare Advantage Insurers Deny Prior Authorization Requests for Post Acute Care at Substantially Higher Rates Than the Overall Denial Rate

    Policy Watch

    Two recent reports find that Medicare Advantage organizations deny prior authorization requests for long-term care hospital, inpatient rehabilitation hospital, and skilled nursing facility stays at higher rates than requests overall. When these decisions are appealed, they are frequently overturned, particularly for skilled nursing facility stays. This may cause delays for Medicare beneficiaries who are particularly vulnerable or have high care needs.

  • Digital Health Tools and Technologies: An Overview of CMS’ Recent Efforts to Expand Their Use in Medicare

    Issue Brief

    As an increasing share of older adults have adopted digital health technologies over the past several years, and with most expressing interest in using them to manage their health care, the Centers for Medicare & Medicaid Services (CMS) has introduced several initiatives to expand the use of digital health technologies in Medicare. This brief summarizes these initiatives and draws on data from various surveys, including KFF Tracking Polls from September 2025 and March 2026, to…

  • Medicare Part D 2008 Data Spotlight: Premiums

    Issue Brief

    This Medicare Part D data spotlight analyzes the premiums charged by the 1,824 stand-alone Medicare Part D plans that will be offered in markets across the country in 2008. The analysis finds premiums charged for Part D plans range widely, from $9.80 per month to $107.50 per month. The average monthly premium would increase from $27.39 in 2007 to $31.99 if enrollees remain in their current plans next year – a 17 percent increase. Nearly…

  • Retiree Health VEBAs: A New Twist On An Old Paradigm

    Issue Brief

    This issue brief provides an overview of stand-alone Voluntary Employees' Beneficiary Association trusts, through which employers have been able to rid themselves of future obligations to pay retiree health benefits in exchange for making a significant payment to designed to approximate the projected cost of these benefits. The paper include three case studies, including the VEBAs at the Big Three automakers. Issue Brief (.pdf)

  • Medicare Part D 2009 Data Spotlight: Ten Most Common Brand-Name Drugs

    Issue Brief

    This Data Spotlight focuses on Part D plan coverage of the ten brand-name drugs that were most commonly prescribed for Medicare beneficiaries in 2006 and lack generic equivalents in 2009. Findings are based on an analysis of data for the 44 unique, national and near-national stand-alone prescription drug plans. The list of the top ten brand-name drugs is based on the number of prescriptions filled in 2006 in all Part D plans. The list includes…

  • Medicare Part D 2010 Data Spotlight: A Comparison of PDPs Offering Basic and Enhanced Benefits

    Report

    This Part D Data Spotlight examines key differences between basic and enhanced Medicare stand-alone prescription drug plans (PDPs), including monthly premiums, cost sharing, and gap coverage. It also examines plan names to assess whether they convey meaningful differences between basic and enhanced PDPs. Companies that sponsor Medicare Part D prescription drug plans are required to offer a basic benefit, either the standard Part D benefit defined by law or an actuarially equivalent benefit design. Plan…