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.

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.

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  • Key Facts About Medicare Part D Enrollment and Costs in 2022

    Issue Brief

    This analysis provides the latest data about Medicare Part D enrollment, premiums, and cost sharing in 2022 and trends over time, including information about stand-alone prescription drug plans (PDPs) and Medicare Advantage prescription drug plans.

  • Medicare Advantage Plans Denied 2 Million Prior Authorization Requests in 2021, About 6% of Such Requests

    News Release

    Medicare Advantage plans denied two million prior authorization requests for health care services in whole or in part in 2021, or about six percent of the 35 million requests submitted on behalf of enrollees that year, a new KFF analysis finds. Prior authorization is intended to ensure that health care services are medically necessary by requiring providers to obtain approval before a service or other benefit is covered. While prior authorization has long been used…

  • The Typical Medicare Beneficiary Has Close to 70 Different Medicare Advantage and Medicare Part D Stand-Alone Plan Options for 2023

    Feature

    The Medicare open enrollment period that runs from October 15 to December 7 each year is an opportunity for Medicare beneficiaries in traditional Medicare and Medicare Advantage to evaluate their current coverage, compare plans, and decide whether to make a change for the coming year. Beneficiaries can compare Medicare Advantage plans, mainly HMOs and PPOs, which provide all Medicare-covered benefits, typically including Part D drug coverage, and may offer other benefits such as vision, dental,…

  • 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…

  • Help with Medicare Premium and Cost-Sharing Assistance Varies by State

    Issue Brief

    This data note provides an overview of programs that help beneficiaries with modest incomes with their Medicare costs, including the Medicare Savings Programs and the Part D Low-Income Subsidy, and highlights findings from corresponding state-level profiles of eligibility and enrollment.

  • State Profiles Highlight Variations in How Many Low-Income Medicare Beneficiaries Get Additional Help with Their Medicare Costs

    News Release

    Medicare beneficiaries with low incomes and modest assets can qualify for additional financial help with Medicare premiums and cost sharing through both the Medicare Savings Programs and Medicare’s Part D Low-Income Subsidy for prescription drug coverage. A new analysis and collection of interactive profiles highlight variations across states in the number and characteristics of beneficiaries who receive this additional financial assistance, including race and ethnicity, gender, and age. These findings reflect differences between states such…