Medicare

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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. 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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  • KFF Analysis: Number of Coronavirus Cases, Distribution of $30B in CARES Act funding and Medicare Advantage Penetration by State

    Fact Sheet

    Number of Coronavirus Cases, Distribution of $30B in CARES Act funding and Medicare Advantage Penetration by StateStateNumber ofCOVID-19 Cases on April 21, 2020Percent of Total COVID-19 CasesFirst Distribution of CARES Act PaymentsPercent of Total Money DistributedPercent of Medicare Beneficiaries in Medicare Advantage, 2020New York253,400.0032.1%$1,859,574,4346.2%40%New Jersey88,806.0011.3%$919,426,8013.1%29%Massachusetts39,643.005.0%$841,425,1202.8%23%Pennsylvania34,005.004.3%$1,246,250,0764.2%41%California33,866.004.3%$2,920,960,7339.7%40%Michigan32,000.004.1%$936,700,1393.1%42%Illinois31,508.004.0%$1,204,103,1804.0%25%Florida27,058.003.4%$2,220,563,1377.4%43%Louisiana24,523.003.1%$474,891,7351.6%38%Connecticut19,815.002.5%$377,981,2571.3%41%Texas20,087.002.5%$2,089,066,4527.0%37%Georgia19,398.002.5%$792,069,1602.6%37%Maryland14,193.001.8%$742,225,3062.5%11%Ohio12,919.001.6%$989,773,4173.3%39%Washington12,486.001.6%$553,838,8061.8%33%Indiana11,688.001.5%$668,604,6142.2%32%Colorado10,112.001.3%$360,905,4821.2%38%Virginia9,097.001.2%$814,360,4672.7%21%Tennessee7,238.000.9%$739,723,3472.5%38%North Carolina6,979.000.9%$919,171,0873.1%36%Missouri5,963.000.8%$618,601,1672.1%35%Rhode Island5,090.000.6%$90,459,8340.3%39%Arizona5,068.000.6%$707,587,4822.4%39%Alabama5,092.000.6%$449,481,9451.5%41%Mississippi4,512.000.6%$374,847,7901.2%20%Wisconsin4,541.000.6%$471,681,0771.6%42%South Carolina4,439.000.6%$518,022,4631.7%28%Nevada3,830.000.5%$241,471,8410.8%36%Utah3,213.000.4%$185,292,4220.6%36%Iowa3,159.000.4%$297,929,1711.0%22%Kentucky3,050.000.4%$452,761,1711.5%34%District of Columbia3,098.000.4%$84,989,0990.3%20%Delaware2,745.000.3%$154,114,1180.5%17%Oklahoma2,680.000.3%$489,853,9981.6%22%Minnesota2,470.000.3%$472,206,1221.6%43%Kansas2,070.000.3%$325,135,9501.1%19%Oregon1,956.000.2%$291,029,0251.0%42%Arkansas1,990.000.3%$326,536,0431.1%26%New Mexico1,971.000.2%$169,486,1320.6%35%South Dakota1,685.000.2%$107,650,2010.4%19%Idaho1,736.000.2%$135,028,0560.5%33%Nebraska1,648.000.2%$225,027,9120.8%17%New Hampshire1,447.000.2%$164,580,3860.5%19%Puerto Rico1,298.000.2%$41,889,8220.1%70%West Virginia908.000.1%$246,574,8510.8%31%Maine875.000.1%$145,763,8120.5%36%Vermont816.000.1%$54,457,8700.2%12%North Dakota627.000.1%$91,064,5790.3%17%Hawaii584.000.1%$132,536,0760.4%44%Montana433.000.1%$111,503,2480.4%18%Alaska321.000.0%$71,248,1230.2%1%Wyoming429.000.1%$66,393,1630.2%3%NOTES: COVID-19 data as of 4/21/2020 at 10:38 AM.SOURCES: Johns Hopkins University, [Coronavirus COVID-19 Global Cases by the Center for…

  • Medicare Beneficiaries Without Supplemental Coverage Are at Risk for Out-of-Pocket Costs Relating to COVID-19 Treatment

    Policy Watch

    Most Medicare Advantage enrollees are in plans that have waived cost sharing for COVID-19 treatment, and many other beneficiaries in traditional Medicare have their cost sharing covered by supplemental insurance. This blog post discusses the 6 million Medicare beneficiaries without supplemental coverage who would face out-of-pocket costs if they require treatment for COVID-19.

  • Possibilities and Limits of Telehealth for Older Adults During the COVID-19 Emergency

    Policy Watch

    Medicare has lifted several restrictions on who can receive telehealth and the types of services they can receive via telehealth during the COVID-19 public health emergency. This post discusses the possibilities and limits of telehealth for older adults, based on findings from the latest KFF Health Tracking Poll.

  • Analysis Estimates Up To 2 Million Uninsured People Could Require COVID-19 Hospitalization

    News Release

    Patients Could Still Be on the Hook for Outpatient Costs, Costs If They Test Negative, and Cost Sharing A new KFF analysis estimates that between 670,000 and 2 million uninsured people around the country eventually could be hospitalized with COVID-19, the respiratory disease caused by the novel coronavirus. Reimbursing hospitals for those treatments could cost between $13.9 billion and $41.8 billion. Trump administration has indicated that it plans to reimburse hospitals for the care of…

  • Problems Getting Care Due to Cost or Paying Medical Bills Among Medicare Beneficiaries

    Issue Brief

    There is ongoing discussion as to whether Congress should waive COVID-19 treatment costs. To inform these discussions, this analysis examines the extent of health care cost-related problems among Medicare beneficiaries. The analysis is based on a composite measure of cost-related burdens that includes problems getting care due to cost, delays seeking care due to cost, and problems paying medical bills among people with Medicare.

  • Examining Medicare Part D Policies for Extended Supplies of Medication

    Issue Brief

    Medicare Part D plan sponsors, which provide drug coverage to 45 million older adults and people with disabilities, have the option to relax their ‘refill too soon’ restrictions in response to the COVID-19 pandemic, as part of efforts to ensure adequate access to medications in disasters or emergencies. This analysis examines the share of Part D enrollees who currently have access to extended supplies of generic, brand-name, and specialty-tier drugs covered by their plan in…

  • How Much Could Medicare Beneficiaries Pay For a Hospital Stay Related to COVID-19?

    Issue Brief

    As the coronavirus continues to spread, the number of people on Medicare admitted to the hospital for COVID-19 related illness is expected to rise. We analyze how much Medicare beneficiaries could pay out-of-pocket for an inpatient hospital admission under traditional Medicare (assuming no supplemental coverage) or Medicare Advantage plans.