Medicare

New & 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.

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.

Related: FAQs on Medicare Financing and Trust Fund Solvency

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  • Medicare Advantage Provider Networks Limit Enrollees to About Half of the Physicians in Their Area That Are Available to Beneficiaries in Traditional Medicare, on Average

    News Release

    With Medicare’s annual open enrollment period underway, a new KFF analysis finds that Medicare Advantage enrollees, on average, had access to just under half (48%) of the physicians in their area who were available to people enrolled in traditional Medicare. The finding illustrates a key tradeoff for beneficiaries in choosing Medicare Advantage.

  • Medicare Beneficiaries Are Not Luddites

    From Drew Altman

    In a new column, President and CEO Dr. Drew Altman discusses new KFF survey data that shows that a surprising share of older adults with Medicare are using health tech regularly, and a solid majority support many of CMS’ goals to make it more widely available. But there are also big income gaps in the use of health tech, and concerns about AI, privacy, and other barriers to rapid and more widespread adoption. “Apparently… a lot of Medicare beneficiaries—but not all beneficiaries equally—are ready for more health tech, and have become tech savvy to survive,” Altman writes.

  • Trump Administration Actions to Curb Data Collection Related to Sexual Orientation and Gender Identity (SOGI)

    Issue Brief

    This brief describes Trump Administration efforts to scale back or modify data collection on sexual orientation and gender identity variables in federal surveys. It specifically focuses on changes in three national surveys that are representative of these efforts: the National Health Interview Survey (NHIS), the Medicare Current Beneficiary Survey (MCBS), and the National Crime Victimization Survey (NCVS).

  • New OIG Report Examines Prior Authorization Denials in Medicaid MCOs

    Policy Watch

    Congress asked the U.S Department of Health and Human Services (HHS) Office of the Inspector General (OIG) to investigate whether Medicaid MCOs are providing medically necessary health care services to their enrollees. OIG found that Medicaid MCOs had an overall prior authorization denial rate of 12.5%–more than 2 times higher than the Medicare Advantage rate. Prior authorization denial rates ranged widely across and within parent firms and states. After a prior authorization request is denied, Medicaid enrollees can appeal, but it’s not always straightforward and many appeals don’t change the initial decision. Unlike in Medicare Advantage, if a Medicaid MCO upholds its original denial, there is no automatic, independent external medical review. OIG found that state Medicaid agency oversight of prior authorization denials is limited. The OIG report underscores concerns about prior authorization and access in Medicaid managed care, keeping this issue at the forefront of ongoing policy discussions.

  • KFF Health Tracking Poll July 2023: The Public’s Views Of New Prescription Weight Loss Drugs And Prescription Drug Costs

    Feature

    About half of adults are interested in taking prescription weight loss drugs. though interest drops when presented with obstacles or drawbacks. Many adults struggle with affording prescription drugs and say there should be more price regulation. Few are aware of provisions in the 2023 Inflation Reduction Act aimed at lowering the drug price for Medicare beneficiaries