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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 Spending Cuts and Hospital Productivity Gains

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman and guest co-author Dana Goldman examine hospital productivity gains, and what they may mean for hospitals’ ability to absorb spending reductions.

  • Medicare Spending Cuts and Hospital Productivity Gains

    News Release

    In his latest column for The Wall Street Journal's Think Tank, Drew Altman and guest co-author Dana Goldman examine hospital productivity gains, and what they may mean for hospitals’ ability to absorb spending reductions. All previous columns by Drew Altman are available online.

  • How Would a Long-Term “Doc Fix” Affect Seniors’ Medicare Costs?

    News Release

    In this new Policy Insight, the Kaiser Family Foundation’s Cristina Boccuti and Tricia Neuman examine how Congress’ effort to permanently stave off scheduled cuts in Medicare’s physician payments could affect what Medicare beneficiaries pay for their care -- both in premiums and in other potential changes -- to offset the cost of the Sustainable Growth Rate (SGR) “doc fix.” Previous columns in the Policy Insights series are also available.

  • A Primer on Medicare: Key Facts About the Medicare Program and the People it Covers

    Report

    This primer explains key elements of the Medicare program, which now provides health coverage to 55 million people -- including 46 million people age 65 and older and another 9 million younger adults with permanent disabilities. It looks at the characteristics of the Medicare population, what benefits are covered, how much people with Medicare pay for their benefits and the program’s overall costs and future financing challenges.

  • Tengo 66 años, trabajo para un gran empleador y tengo cobertura de seguro médico a través de mi trabajo. Planeo seguir trabajando unos años más y mantener la cobertura que ofrece mi empleador. ¿Cuáles s...

    FAQs

    Cuando deje de trabajar y/o finalice su cobertura a través de su trabajo, debe inscribirse en la Parte A y la Parte B de Medicare. Si es elegible para la Parte A sin prima, puede inscribirse en cualquier momento después de ser elegible por primera vez. Su cobertura de la Parte A será retroactiva 6 meses desde el momento en que se inscriba (pero no antes del primer mes en el que fue elegible). Tiene…

  • Mental Health and Substance Use Disorder Coverage in Medicare Advantage Plans

    Issue Brief

    This brief describes the scope of mental health and substance use disorder benefits in Medicare Advantage plans, including extra benefits, cost sharing, and prior authorization and referral requirements, based on an analysis of the Centers for Medicare and Medicaid Services (CMS) Medicare Advantage plan benefit and enrollment files for 2022.

  • Half of All Eligible Medicare Beneficiaries Are Now Enrolled in Private Medicare Advantage Plans

    Policy Watch

    Recently released data show that Medicare Advantage, the private plan alternative to traditional Medicare, now covers half of eligible Medicare beneficiaries. As the role of Medicare Advantage grows, so will interest in understanding how well the program serves the increasingly diverse group of enrollees who receive their Medicare coverage from private insurers.

  • Testimony: Prior Authorization in Medicare Advantage

    Issue Brief

    Jeannie Fuglesten Biniek, an Associate Director for the Program on Medicare Policy at KFF, testified before the Senate Homeland Security and Government Affairs Committee Permanent Subcommittee on Investigations on May 17, 2023 as part of a hearing on Examining Health Care Denials and Delays in Medicare Advantage.

  • KFF Survey of Consumer Experiences with Health Insurance

    Poll Finding

    The survey finds nearly six in 10 people with health insurance experienced a problem using their insurance in the past year, with even larger shares reporting problems among people who are sick or who have mental health needs. It includes data for people with different types of coverage, including employer, Marketplace, Medicare and Medicaid, and also examines affordability issues and mental health access.