Medicare

NEW AND NOTEWORTHY

What to Know About Medicare Coverage of Telehealth

Congress has repeatedly extended pandemic-era flexibilities around Medicare coverage of telehealth, but most such flexibilities remain temporary. This brief answers key questions about the current scope of Medicare telehealth coverage, including both temporary and permanent changes adopted through legislation and regulation, and future policy considerations.

Changes to the Medicare Advantage Program Enhance Some Consumer Protections But Roll Back Others

CMS recently finalized policies as part of the 2027 Medicare Advantage final rule that both enhance consumer protections and roll back changes to the Medicare Advantage program that were intended to protect consumers. These changes have gotten less attention than payment issues and changes to the star ratings system, which also affect plan payments, but could have implications for Medicare beneficiaries.

Examining the Potential Impact of Medicare’s New WISeR Model

A federal initiative to establish new prior authorization requirements in traditional Medicare, called the Wasteful and Inappropriate Service Reduction (WISeR) model, is likely to have only modest impact in its first year.

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. u003cbru003eu003cbru003eExplore 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.u003cbru003eu003cbru003eu003ca href=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022 data-type=u0022linku0022 data-id=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022u003eRelated:u003ca href=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022u003e FAQs on Medicare Financing and Trust Fund Solvencyu003c/au003eu003c/au003e

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  • How the Republican Health Agenda Could Play Out

    From Drew Altman

    In this Wall Street Journal Think Tank column Drew Altman discusses how Republicans will assume ownership of health care’s policy and political problems as they assume control, and how that may affect their plans for the Affordable Care Act, Medicaid and Medicare.

  • Medicare Part D: A First Look at Medicare Prescription Drug Plans in 2021

    Issue Brief

    This issue brief provides an overview of the Medicare Part D prescription drug benefit plan landscape for 2021, with a focus on stand-alone drug plans. It includes national and state-level data on plan availability, premiums, benefit design, cost sharing, information about premium-free plans for low-income beneficiaries, and information about the national Part D drug plans available in 2021.

  • 7 in 10 Medicare Beneficiaries Report That They Did Not Compare Their Coverage Options During a Recent Open Enrollment Period

    News Release

    With the Medicare open enrollment period set to begin October 15, a new KFF analysis finds that 7 in 10 beneficiaries (71%) say that they didn’t compare their coverage options during a recent open enrollment season. Twenty-nine percent said they did compare Medicare plans. But not shopping around can have a big impact on enrollees’ coverage and costs. The Centers for Medicare & Medicaid Services (CMS) recommends that beneficiaries review and compare Medicare plans each…

  • New Interactive Provides Essential Facts and Trends Related to Medicare Spending

    News Release

    A new KFF interactive provides essential facts and trends about spending on Medicare, the federal health insurance program that covers 65 million seniors and people with disabilities, or nearly 1 in 5 Americans. In 2020, Medicare spending accounted for 12 percent of the federal budget and 20 percent of national health care spending. Given its size and importance, the program is often part of discussions about how to better manage total federal government spending, health…

  • I decided not to sign up for a Part D drug plan when I first qualified for Medicare when I turned 65 last year, but now I want to enroll in a drug plan during the Medicare Open Enrollment period. Can I...

    FAQs

    Yes, you can sign up for a Part D plan during the Medicare Open Enrollment period. However, you may also owe a late enrollment penalty because you didn’t sign up for Part D drug coverage when you first became eligible for Medicare. The penalty is equal to 1% of the national average premium amount for every month you didn't have coverage as good as the standard Part D benefit.

  • I’m turning 65 soon, but I like my current insurance. Do I have to enroll in Medicare? Will there be penalties if I don’t?

    FAQs

    It depends on how you are receiving your current insurance. If you are receiving employer-sponsored health insurance through either your or your spouse’s job when you turn 65, you may be able to keep your insurance until you (or your spouse) retire(s). You will need to contact your employer’s benefits representative to find out whether they will continue your coverage when you turn 65. Since Medicare Part A is premium-free for most beneficiaries, you may…

  • How can I compare my Medicare coverage options?

    FAQs

    You can compare your Medicare coverage options using an online searchable tool on the Medicare.gov website that allows users to compare Medicare coverage options, including Medicare Advantage plans, Medicare Part D plans, and Medigap supplemental policies. You can get information about the coverage, costs, and benefits of different plan options in your area using the Medicare coverage comparison website. You can also enroll in a Medicare Advantage plan or a Medicare Part D plan on…

  • Chart Reviews Increase Payments to Medicare Advantage Insurers for 1 in 6 Enrollees

    Issue Brief

    Using Medicare Advantage encounter data, this analysis finds that 62% of Medicare Advantage enrollees have at least one chart review record and that diagnoses added from chart reviews increase payments from CMS to insurers for 17% of enrollees. The use of chart reviews varies across the largest Medicare Advantage insurers.