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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  • Health Reform Opportunities: Improving Policy for Dual Eligibles

    Issue Brief

    As the nation considers national health reform, this brief provides an overview of opportunities to realign federal and state policy for the dual eligibles to promote a more rational, cost-efficient system for 9 million of the poorest, sickest and highest-cost people covered by both Medicaid and Medicare. Navigating two programs with different rules and financing incentives is complex for beneficiaries and providers, impedes efforts to improve care coordination and results in cost-shifting between programs that…

  • Navigating Medicare and Medicaid: A Resource Guide for People with Disabilities, Their Families, and Their Advocates

    Report

    Navigating Medicare and Medicaid: Resource Guides for People with Disabilities, Their Families, and Their Advocates These guides explain the critical role Medicare and Medicaid have come to play in the lives and the futures of roughly 20 million children, adults, and seniors with disabilities - and give people with disabilities new information to help them get the most from these programs. Navigating Medicare and Medicaid, 2005 Keeping Medicare and Medicaid When You Work, 2005

  • Medicare Part D 2010 Data Spotlight: Coverage of Top Brand-Name and Specialty Drugs

    Issue Brief

    This Part D Data Spotlight documents the wide variations across the private stand-alone drug plans with respect to coverage of drugs, what enrollees pay for those drugs, and restrictions and limitations placed on their use. These variations have potentially significant implications for beneficiaries’ access to medications and out-of-pocket costs. The spotlight is one in a series analyzing key aspects of the Medicare Part D drug plans that will be available to beneficiaries in 2010. The…

  • Medicare Part D 2008 Data Spotlight: Benefit Design

    Issue Brief

    This Medicare Part D data spotlight examines the benefit design of Medicare Part D Prescription Drug Plans (PDP) in 2008, focusing on national plans. It shows that in 2008, as in previous years, only about 10 percent of national prescription drug plans offered the defined standard benefit. The spotlight also looks at cost sharing structures, the use of flat dollar copayments, the upward trend in cost sharing for non-preferred drugs, and recent changes in cost…

  • Medicare Prescription Drug Improvement and Modernization Act Implementation Timeline: June 2004 – December 2006 Key Dates

    Report

    Key Implementation Dates for the Medicare Prescription Drug Benefit This timeline presents important dates and deadlines of key implementation activities related to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). It runs from the beginning of 2005 through the end of 2006, the first year of the new Medicare drug benefit. Some of these dates are defined in the MMA statute, while others are from the final rule issued by the Centers…

  • Medicare Part D 2010 Data Spotlight: Benefit Design and Cost Sharing

    Report

    The Medicare Modernization Act established a defined standard drug benefit for Part D stand-alone Prescription Drug Plans (PDPs) and Medicare Advantage Prescription Drug (MA-PD) plans, while giving plans flexibility to offer alternative benefit designs. Only about one in 10 PDPs offer the standard benefit in 2010. Plan sponsors can offer alternative benefit designs that are, at a minimum, actuarially equivalent to the defined standard and can also offer enhanced benefits. This Medicare Part D data…

  • Summary of Key Changes to Medicare in 2010 Health Reform Law   

    Issue Brief

    Summary of Key Changes to Medicare in 2010 Health Reform Law . This brief provides a detailed look at the improvements in Medicare benefits, changes to payments for providers and Medicare Advantage plans, various demonstration projects and other Medicare provisions in the law. It includes a timeline of key dates for implementing the Medicare-related provisions in the law.

  • Explaining Health Care Reform: What is Comparative Effectiveness Research?

    Issue Brief

    The brief examines current funding for comparative effectiveness research, the provisions included in the current health reform legislation, and issues related to which treatments that might be studied, whether and how to weigh costs of care, and how such findings will be used and shared with health-care practitioners and the public. It is part of the Foundation's series of Explaining Health Reform briefs on key concepts in health reform. Brief (.pdf)

  • Massachusetts’ Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries

    Issue Brief

    Massachusetts is the first state to finalize a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to test CMS's capitated financial alignment model for beneficiaries who are dually eligible for Medicare and Medicaid, with enrollment beginning on April 1, 2013. Starting in 2013, CMS will implement a three-year multi-state demonstration to test new service delivery and payment models for people who are eligible for both federal health programs. Massachusetts' demonstration…