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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  • FAQs on Health Spending, the Federal Budget, and Budget Enforcement Tools

    Issue Brief

    As some policymakers in Washington are pushing to reduce the federal deficit and debt, this brief 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. These FAQs answer basic questions about health spending and the federal budget and budget enforcement tools, including the debt limit and sequestration.

  • 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,…

  • Medicare Advantage Insurers Report Much Higher Gross Margins Per Enrollee Than Insurers in Other Markets

    News Release

    A new analysis of health insurers’ 2021 financial data shows that insurers continue to report much higher gross margins per enrollee in the Medicare Advantage market than in other health insurance markets. The analysis examines insurers’ financial data in the Medicare Advantage, Medicaid managed care, individual (non-group), and fully insured group (employer) markets. In 2021, Medicare Advantage insurers reported gross margins averaging $1,730 per enrollee, at least double the margins reported by insurers in the…

  • Is the Biden Administration Proposing Cuts to Medicare Advantage?

    Policy Watch

    Recent announcements by the Administration to improve the accuracy of payments and improve program integrity of Medicare Advantage are unlikely to have a major impact on the program, the insurance industry or beneficiaries, given relatively generous payments to plans and the robustness of the market for private Medicare plans.

  • Medicare Advantage Plans Denied 2 Million Prior Authorization Requests in 2021, About 6% of Such Requests

    News Release

    Medicare Advantage plans denied two million prior authorization requests for health care services in whole or in part in 2021, or about six percent of the 35 million requests submitted on behalf of enrollees that year, a new KFF analysis finds. Prior authorization is intended to ensure that health care services are medically necessary by requiring providers to obtain approval before a service or other benefit is covered. While prior authorization has long been used…

  • Two KFF Analyses Explore the Demographics of People Jointly Enrolled in Medicare and Medicaid As Well As Program Enrollment and Spending for This Population

    News Release

    The 12.5 million people who are jointly enrolled in Medicare and Medicaid include some of the poorest individuals in the U.S. with some of the highest health needs, requiring disproportionately high spending from both programs to support them. Two new KFF analyses examine the demographics of this population as well as the latest data on program enrollment and spending.  These data can help inform federal and state policy discussions about ways to improve coordination and…

  • Enrollment and Spending Patterns Among Medicare-Medicaid Enrollees (Dual Eligibles)

    Issue Brief

    This brief examines national and state-level data on enrollment and spending for Medicare-Medicaid enrollees using the 2019 and 2020 Medicare Beneficiary Summary Files and the 2019 Transformed Medicaid Statistical Information System (T-MSIS). Spending data for Medicare includes beneficiaries in traditional Medicare only, since spending data for beneficiaries enrolled in Medicare Advantage plans are unavailable. State-level data on Medicare-Medicaid enrollment and spending are available through KFF’s State Health Facts.