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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  • Poll: 1 in 8 Adults Say They’ve Taken a GLP-1 Drug, Including 4 in 10 of Those with Diabetes and 1 in 4 of Those with Heart Disease 

    News Release

    About one in eight adults (12%) say they have taken one of an increasingly popular class of prescription drugs known as GLP-1s that are used for weight loss and to treat diabetes and reduce the risk of heart disease and stroke, a new KFF Health Tracking Poll finds. This includes 6% of adults who say they are currently taking one of these drugs, which include Ozempic, Wegovy and MounjaroThe shares of adults who report ever…

  • 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…

  • 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).

  • Medicare Advantage Insurers Made Nearly 53 Million Prior Authorization Determinations in 2024

    Issue Brief

    Nearly 53 million prior authorization requests were submitted to Medicare Advantage insurers on behalf of Medicare Advantage enrollees in 2024, of which 4.1 million (7.7%) were denied. Just 11.5% of denied requests were appealed, though 80.7% of appeals overturned the initial denial in Medicare Advantage. Substantially fewer prior authorization requests were made in traditional Medicare, reflecting the small number of services subject to prior authorization requirements.

  • Are covered benefits and cost-sharing requirements under Medicare Advantage plans the same? How can I compare?

    FAQs

    All Medicare Advantage plans cover the same services that are covered by traditional Medicare. However, not all Medicare Advantage plans have the same cost-sharing requirements. The deductibles, premiums, and cost sharing for services vary by plan. And plans may cover benefits not covered by traditional Medicare. For example, most Medicare Advantage plans offer coverage of dental, hearing, and vision services, although the scope of coverage varies. To compare the costs and benefits of different Medicare…

  • I am about to turn 65 and sign up for Medicare but I’m not sure what my options are for coverage. Where can I go for more information?

    FAQs

    To learn more about your coverage options under Medicare, including the Medicare Advantage plans, Part D prescription drug plans, and Medicare supplement policies (Medigap) available in your area, and how to enroll, you can go to the Medicare coverage comparison website, a searchable tool on the Medicare.gov website, or call 1-800-MEDICARE (1-800-633-4227). You can also contact the State Health Insurance Assistance Program (SHIP) in your state or the Social Security Administration. SHIPs offer local, personalized…

  • Is there a lifetime limit on the number of times a person can switch Medicare Advantage and Medicare Part D plans, or can I shop around and switch every year if I want to?

    FAQs

    You may switch Medicare Advantage and Part D plans every year during the annual Medicare Open Enrollment period (October 15 through December 7), and, if you are enrolled in a Medicare Advantage plan, you can also switch during the Medicare Advantage Open Enrollment period (January 1 through March 31). It is generally a good idea to compare your plan options every year, even if you are happy with your current coverage, since plans often make…