Medicare

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Decoding Medicare Advantage Coding Intensity

In recent years, federal payments to Medicare Advantage plans, and how they are adjusted for enrollee health status, have come under increased scrutiny. This brief answers key questions about coding intensity, recent steps taken by CMS to address the impact of coding on payment, the effects on Medicare beneficiaries, and other proposals to improve Medicare Advantage payment accuracy.

State Profiles for Dual-Eligible Individuals

This data collection draws on Medicare and Medicaid administrative data to present national and state-level information on people who are covered by both Medicare and Medicaid, referred to as dual-eligible individuals (also known as dually-enrolled beneficiaries).

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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  • 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…

  • Prices Increased Faster Than Inflation for Half of all Drugs Covered by Medicare in 2020

    Issue Brief

    Recent legislation would require drug companies to pay rebates to the federal government when annual increases in prescription drug prices for Medicare and private insurance exceed the rate of inflation. As context for understanding the possible impact of this proposal, this analysis compares price changes for drugs covered by Medicare Part B (administered by physicians) and Part D (retail prescription drugs) between 2019 and 2020 to the inflation rate over the same period.

  • Health Insurer Financial Performance in 2024

    Issue Brief

    This analysis of trends in health insurers’ financial data shows that insurers’ gross margins per enrollee dipped slightly in 2024 across four markets, remaining highest in the Medicare Advantage market, followed by the individual (non-group) market, the fully insured group (employer) market, and Medicaid managed care. The analysis also examines insurers’ medical-loss ratios across the four markets.

  • As Debate Heats Up in Washington Over Possible Entitlement Cuts, A New KFF Analysis Details the 30% of Federal Spending That Goes to Health Care Programs

    News Release

    As some policymakers in Washington are pushing to reduce the federal deficit and debt, a new KFF resource provides a concise explanation of federal spending for domestic and global health programs and services, which could be part of any conversation about curbing federal spending. Federal spending on health programs and services accounted for 30 percent of net federal spending in fiscal year 2022 -- or $1.7 trillion out of a total of $5.9 trillion. Specifically,…

  • Unpacking the Controversy Over Medicare Advantage

    Event Date:
    Event

    Medicare Advantage is the rapidly growing private plan alternative to traditional Medicare that provides coverage to approximately half of Medicare beneficiaries. On Tuesday, March 21, three experts joined series moderator Larry Levitt in a 45-minute discussion on Medicare Advantage, addressing such questions as: What has driven the growth in Medicare Advantage enrollment? What are the implications of enrollment being concentrated in a few insurance firms? Is the federal government overpaying plans? What would the new…

  • Access To Health Care:

    Report

    Promises and Prospects For Low-Income Americans This book explores critical issues affecting access to health care for low-income Americans by assessing the importance of expansions of health coverage for the poor, the emerging challenges providers who serve low-income and uninsured populations face in a rapidly evolving health care delivery system, and the effects of these changes on particularly vulnerable populations. Articles include: IntroductionMarsha Lillie-Blanton, Rose Marie Martinez, Barbara Lyons, Diane Rowland A Review Of The…

  • 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…

  • Medicare Part D Spotlight: Part D Plan Availability in 2010 and Key Changes Since 2006

    Issue Brief

    This Medicare Part D data spotlight examines the stand-alone Medicare drug plan options that will be available to beneficiaries in 2010, including the number of available plans, premiums for those plans, and benefit designs. About two-thirds of the nearly 27 million Medicare beneficiaries who are enrolled in Part D plans get their coverage through stand-alone plans. The analysis is based on the 2010 Medicare drug plan information released by the Centers for Medicare & Medicaid Services…