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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  • What to Know About How Medicare Pays Physicians

    Issue Brief

    Each year, the Centers for Medicare & Medicaid Services (CMS) updates Medicare payments for physician services and other Part B services through rulemaking. This issue brief answers key questions about how physicians are paid under the Medicare program, and reviews policy options under discussion for payment reform.

  • I want to switch from Medicare Advantage to traditional Medicare, but I still want drug coverage. What do I need to do?

    FAQs

    If you switch from a Medicare Advantage plan to traditional Medicare and you want drug coverage, you can sign up during the Medicare Open Enrollment period for a stand-alone prescription drug plan in your area. Your new coverage will take effect on January 1. You can also switch from Medicare Advantage to traditional Medicare during the Medicare Advantage Open Enrollment period between January 1 and March 31, when you can sign up for a stand-alone…

  • How and when can I switch from Medicare Advantage to traditional Medicare? Is there a form I need to fill out? Can I make that change during the Medicare Open Enrollment period?

    FAQs

    If you’re already in a Medicare Advantage plan and you want to switch to traditional Medicare, you should contact your current plan to cancel your enrollment and call 1-800-MEDICARE (1-800-633-4227). Note there are specific enrollment periods each year to do this. The first period when you can switch from your Medicare Advantage plan to traditional Medicare is during the Medicare Open Enrollment period that runs October 15 to December 7. When you make the switch…

  • Prescription Drug Spending Under The MMA: Modeling The Impact On Out-of-Pocket Costs

    Event Date:
    Event

    This report projects the impact of the new Medicare drug benefit on out-of-pocket spending for people who enroll in 2006. The analysis is based on a model developed by the Actuarial Research Corporation for the Kaiser Family Foundation. The model generally conforms to the Congressional Budget Office’s assumptions and projections about Medicare drug benefit spending and participation rates for the new benefit and for the low-income subsidy. The report was released at a briefing in…

  • My husband and I are retired. He just turned 65 and is now covered by Medicare, but I am 62 and I don’t have health insurance. As the spouse of a Medicare beneficiary, can I enroll in Medicare during th...

    FAQs

    No. Although your husband now qualifies for Medicare, you will not qualify for Medicare until you turn age 65. If you do not have health insurance now, you can consider signing up for health insurance coverage through a Marketplace plan. If your household income is at least 100% of the federal poverty level (for buying Marketplace coverage in 2026, that means an income of $21,150 for a couple), you may qualify for premium tax credits…

  • Medigap May Be Elusive for Medicare Beneficiaries with Pre-Existing Conditions

    Issue Brief

    This issue brief analyzes federal and state guaranteed issue rules and how they impact beneficiaries’ access to Medigap, including the implications for Medicare beneficiaries with pre-existing conditions and those under age 65 with long-term disabilities. This brief also explores a recently finalized rule: Nondiscrimination in Health Programs and Activities regarding Section 1557 of the Affordable Care Act that may have implications for the Medigap market.

  • Key Facts About Hospitals

    Feature

    This analysis presents key facts about hospitals with more than 40 charts related to national spending on hospital care, characteristics of the hospital industry, rural hospitals, use of hospital care, out-of-pocket spending and medical debt, hospital prices, hospital finances, and charity care.

  • Medicare’s Role for Women

    Fact Sheet

    Medicare’s Role for Women This fact sheet highlights Medicare’s important role in providing women with health care coverage. It examines the demographic profile of women on Medicare, including their health and income status, the program’s benefits and cost-sharing requirements, and the prevalence of supplemental coverage to fill gaps in Medicare’s coverage. Fact Sheet (.pdf)