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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  • Insulin Costs and Coverage in Medicare Part D

    Issue Brief

    In light of heightened attention to insulin and the Trump Administration’s new Part D model to address out-of-pocket costs for insulin for Medicare beneficiaries, we analyzed out-of-pocket spending on insulin by beneficiaries enrolled in Part D drug plans, variation in Part D plan formulary coverage and tier placement of insulin products, and trends in prices for insulin.

  • How Could the Price of Remdesivir Impact Medicare Spending for COVID-19 Patients?

    Issue Brief

    This brief discusses how drugs provided in inpatient hospital settings are covered and reimbursed for beneficiaries in traditional Medicare under current law. This is relevant for Medicare spending on COVID-19 patients who receive Gilead’s new antiviral drug remdesivir. We discuss the implications for hospitals and the Medicare program of spending on remdesivir.

  • FAQs on Medicare Coverage and Costs Related to COVID-19 Testing and Treatment

    Issue Brief

    These FAQs provide the latest guidance on testing and treatment related to COVID-19 for Medicare beneficiaries, including questions related to out-of-pocket costs, the COVID-19 vaccine, telehealth, extended supplies of medication, skilled nursing facility stays, and issues for people in private Medicare Advantage plans.

  • 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.

  • 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…

  • Nearly 7 in 10 Medicare Beneficiaries Did Not Compare Plans During Medicare’s Open Enrollment Period

    Issue Brief

    This brief examines the share of Medicare beneficiaries who reviewed their coverage and compared plans during the open enrollment period for 2022 (that takes place in the Fall of 2021), and who made use of Medicare’s official information resources, as well as variations by demographic groups. Overall, nearly 7 in 10 Medicare beneficiaries did not compare their own source of Medicare coverage with other Medicare options offered in their area.

  • Nearly 7 in 10 Medicare Beneficiaries Do Not Compare Coverage Options During Open Enrollment  

    News Release

    With open enrollment less than a month away, a new KFF analysis suggests that the vast majority of the nation’s 67 million Medicare beneficiaries will not shop around among the coverage options for 2025 or switch plans. It’s a decision that could have a significant impact on enrollees’ coverage and costs. The analysis of federal data shows that nearly 7 in 10 Medicare beneficiaries (69%) did not  compare their Medicare coverage with other Medicare options…