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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  • New $2,000 Medicare Part D Cap Could Reduce Out-of-Pocket Drug Costs for Over One Million Beneficiaries Beginning Next Year, Including Tens of Thousands of Beneficiaries in Most States 

    News Release

    A KFF analysis shows that a new out-of-pocket spending cap in Medicare Part D could translate into savings for well over 1 million beneficiaries when it takes effect next year, including more than 100,000 people each in California, Florida and Texas, based on analyses of drug spending in 2021. The $2,000 cap, part of the Inflation Reduction Act of 2022, will lead to thousands of dollars in savings for Medicare patients who take high-cost drugs…

  • Millions of People with Medicare Will Benefit from the New Out-of-Pocket Drug Spending Cap Over Time

    Issue Brief

    In 2025, Medicare beneficiaries will pay no more than $2,000 out of pocket for prescription drugs covered under Part D, Medicare’s outpatient drug benefit, due to a provision in the Inflation Reduction Act of 2022. This analysis examines how many Medicare Part D enrollees spent $2,000 or more out of pocket in 2021 and over multiple years, both nationally and at the state level, to show how many people over time could benefit from the…

  • Low Incomes, Little Savings: Many Medicare Beneficiaries Have Modest Financial Resources to Draw Upon in Retirement 

    News Release

    A new KFF analysis shows that most Medicare beneficiaries live on relatively low incomes and have modest financial resources for retirement – posing a risk to their economic well-being, particularly if they were to have a major, unanticipated expense, such as a need for long-term nursing home care. The financial picture is especially bleak among Black and Hispanic Medicare beneficiaries, who tend to have lower incomes, savings, and home equity than White beneficiaries, the analysis…

  • 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…

  • How Does Use of Medicaid Wraparound Services by Dual-Eligible Individuals Vary by Service, State, and Enrollees’ Demographics?

    Issue Brief

    This issue brief describes the share of dual-eligible individuals with full Medicaid benefits who use wraparound services, including institutional LTSS, home- and community-based services (HCBS), vision services, dental care, and non-emergency medical transportation (NEMT); and how use of these services varies by state and select demographic characteristics of enrollees.

  • Florida’s Plan to Import Prescription Drugs from Canada, the First of its Kind, May Face Obstacles that Could Delay Implementation and Savings

    News Release

    A new KFF policy watch explains some of the hurdles the state of Florida still must clear before it can implement its novel plan to make some prescription drugs more affordable by importing them from Canada. Florida’s plan represents the first time the Food and Drug Administration (FDA) has granted authority for a state to safely import prescription drugs from another country. However, the state must take some additional steps to move forward with the…

  • What to Know About the FDA’s Recent Decision to Allow Florida to Import Prescription Drugs from Canada

    Policy Watch

    Florida’s plan to import certain prescription drugs from Canada represents the first time the Food and Drug Administration (FDA) has granted authority for a state to safely import prescription drugs from another country. This policy watch analysis unpacks some frequently asked questions related to state of Florida’s importation plan, including potential obstacles to implementation, who will benefit from any savings, and what types of drugs will (and will not) qualify for importation.

  • The CBO Report That Didn’t Roar

    From Drew Altman

    In his latest column, KFF President and CEO Drew Altman discusses a recent Congressional Budget Office (CBO) estimate that the Centers for Medicare and Medicaid Innovation (CMMI)'s payment and delivery demonstrations have cost Medicare money, and what it means for the future of value-based payment.