Medicare

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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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  • Vaccination Rates Are Relatively High for Older Adults, But Lag in Counties in the South, in Counties with Higher Poverty Rates and in Counties that Voted for Trump

    Issue Brief

    This analysis uses CDC data to look at vaccination rates for adults 65 and older. The findings show that vaccination rates vary by county and that adults ages 65 and older are less likely to be fully vaccinated in counties in the South, in counties where a higher share of older adults live in poverty, and in counties that voted for Trump.

  • 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.

  • Gaps in Medicare Advantage Data Remain Despite CMS Actions to Increase Transparency

    Issue Brief

    The Centers for Medicare and Medicaid Services has recently taken actions to increase transparency in Medicare Advantage, however substantial data gaps remain that limit the ability of policymakers and researchers to conduct oversight and assess the program's performance, and for Medicare beneficiaries to compare Medicare Advantage plans offered in their area.

  • The Vast Majority of Nursing Facilities Will Need to Hire More Staff to Comply with the Final Federal Rule When Fully Implemented, Unless They Qualify for an Exemption

    News Release

    Based on a new KFF analysis, fewer than 1 in 5 (19%) nursing facilities currently meet the minimum staffing standards set out in the final requirements of the federal rule released today by the Centers for Medicare and Medicaid Services (CMS). CMS adopted staffing standards that are similar to the staffing requirements in the rule proposed last year, which included minimum staff levels of 0.55 registered nurses and 2.45 nurse aide hours per resident day.…

  • Coverage of Sexual and Reproductive Health Services in Medicare

    Issue Brief

    This brief describes Medicare coverage of sexual and reproductive health services, including contraception, and compares that coverage with private insurance plans and Medicaid. These benefits are particularly relevant to nearly 1 million women of reproductive age (20-49) who are eligible for Medicare due to having a long-term disability.

  • New KFF Poll Finds that Many Older Voters Are Unaware of Medicare Drug Price Negotiation, But Awareness Has Grown

    News Release

    A new KFF poll finds that many older voters are unaware of the provision in the Inflation Reduction Act that for the first time requires the federal government to negotiate the price of some prescription drugs in the Medicare program, a key campaign issue for President Joe Biden. The 48% of voters ages 65 and older who are aware of the landmark change represents a 12 percentage point increase from November, the poll shows.  Fifty-two…

  • 3 Charts: Medicare Drug Price Negotiations

    News Release

    Under the Inflation Reduction Act, the federal government for the first time will negotiate directly with drug companies to determine the prices that Medicare will pay for certain high expenditure drugs covered under Medicare Part D (starting in 2026) and Part B (starting in 2028). Part D covers retail prescription drugs and Part B covers physician-administered medications. This new requirement is the culmination of years of debate among lawmakers in Congress, and the Centers for…

  • What are the Consequences of Health Care Debt Among Older Adults?

    Issue Brief

    Health care debt is a widespread problem in the United States. Medicare offers coverage for a range of health care services, including hospitalizations, physician visits, prescription drugs, and post-acute care, but Medicare beneficiaries generally pay out-of-pocket for their monthly premiums and deductibles, cost-sharing for Medicare-covered services, and the cost of services not covered by Medicare. This data note examines findings from the KFF Health Care Debt Survey to assess the prevalence, sources and consequences of…