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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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  • Medicaid and the Elderly

    Other Post

    Long-Term Care Spending In 1993, Medicaid spent $25.5 billion for long-term care services for elderly beneficiaries (Figure 5). This represents 58 percent of the $44 billion Medicaid spent on long-term care services for all population groups. The majority of spending was for care delivered in nursing facilities (84 percent) and ICFs-MR (2 percent). The remaining 14 percent of Medicaid long-term care spending went towards community-based care, including 3 percent for mental health services and 11…

  • Pulling it Together: Duals: The National Health Reform Experiment We Should Be talking More About

    From Drew Altman

    The Center for Medicare & Medicaid Services (CMS) and 26 states are moving to launch a large scale managed care demonstration project potentially involving millions of the poorest, sickest, most expensive Medicare and Medicaid beneficiaries, the so-called dual eligibles. The experiment is getting more and more attention from policy experts, but with controversial issues like the survival of the Affordable Care Act and converting Medicare to a premium support program grabbing the limelight, it has…

  • Medicare Part D: A First Look at Part D Plan Offerings in 2013

    Report

    This data spotlight examines the stand-alone Part D drug plan options available to Medicare beneficiaries in 2013 during the open enrollment period, which runs from October 15 to December 7, 2012. The analysis is the first in a series of planned reports examining the private plan choices available to Medicare beneficiaries for 2013. It is authored by Jack Hoadley and Laura Summer of Georgetown University, Juliette Cubanski and Jennifer Huang of the Kaiser Family Foundation,…

  • Medicare Part D 2008 Data Spotlight: Formularies

    Issue Brief

    This Medicare Part D data spotlight examines the formularies (list of covered drugs) of Medicare stand-alone prescription drug plans in 2008, changes since 2006, and differences in how plans cover brand-name and generic drugs. This is one in a series analyzing key aspects of the 2008 Medicare Part D prescription drug plan choices. It analyzes data from the 47 stand-alone prescription drug plans available nationwide using a sample of commonly-used and high-cost prescription drugs. The…

  • Inside Deficit Reduction: What It Means for Medicare

    Event Date:
    Event

    Proposals to generate Medicare savings abound, from the various commissions recommending change, members of Congress and others. Which proposals will, or should receive serious considerations by the Congressional super committee in its quest to find $1.2 trillion or more in savings by its November 23 deadline? What impact would these changes have on beneficiaries, providers and insurers? Would stakeholders prefer the automatic, but capped, Medicare reductions in the sequester rather than any recommendations on Medicare…

  • I am 54 and living with a permanent disability, and for the past 12 months I have been receiving Social Security disability insurance (SSDI) payments. But I do not have health insurance. I am required t...

    FAQs

    Yes, you are eligible to purchase coverage through the Marketplace, and if your income is between at least 100% of poverty (for buying Marketplace coverage in 2026, that means an income of $15,650 for an individual) you will qualify for premium tax credits to help make Marketplace coverage more affordable. If you live in a state that has expanded its Medicaid program to cover adults under age 65 with incomes up to 138% of poverty…

  • I am 70 years old and covered by Medicare, but I’m wondering if I can purchase one of the health plans offered through the Marketplace and drop my Medicare coverage? Is that an option for me or should I...

    FAQs

    If you have Medicare, you should keep it. In fact, companies that sell Marketplace plans are prohibited from selling these plans to you if they know you are covered by Medicare. And if you are eligible for premium-free Medicare Part A, you are not eligible to receive the Marketplace premium tax credit to help reduce the cost of a Marketplace policy, even if you would qualify based on your income. If you do drop Medicare…

  • I am enrolled in a Medicare Advantage plan, but have recently made plans to do some traveling throughout the United States. Will my plan provide the same coverage in all the states I visit?

    FAQs

    Not necessarily. You will need to contact the company that is offering your plan to find out if or which benefits are available out-of-state. If your plan does not offer out-of-state coverage, there may be another plan offered by the same firm that does, or a similar plan offered by another firm in your area. If you decide that you would like to switch to a different plan, however, note that you will need to…

  • 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.  Such plans can be appealing to beneficiaries because they offer extra benefits and cap out-of-pocket costs without the need for supplemental coverage. But…

  • Health Policy 101 Introduction

    Feature

    Health Policy 101 is a comprehensive guide covering fundamental aspects of U.S. health policy and programs, including Medicare, Medicaid, the Affordable Care Act, employer-sponsored insurance, the uninsured population, health care costs and affordability, women's health issues, and health care politics. It includes overviews of private health insurance regulation, racial and ethnic disparities, public health, international comparison of health systems, U.S. global health policy, and the federal role in health policy. The chapters can be downloaded…