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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  • The Uncertain Future of Medicare’s Stand-Alone Prescription Drug Plan Market and Why It Matters

    Issue Brief

    This brief focuses on the stand-alone Medicare Part D prescription drug plan marketplace and its somewhat uncertain future, in light of recent trends in plan availability and the potential for another year of premium increases in 2026, in part depending on what the Trump administration decides to do with the temporary Part D premium stabilization demonstration. The brief explains why the stability of the PDP market matters, both for people in traditional Medicare who want…

  • Key Facts About Medicare Part D Enrollment, Premiums, and Cost Sharing in 2025

    Issue Brief

    The Medicare Part D program provides an outpatient prescription drug benefit to more than 50 million older adults and people with long-term disabilities in Medicare who enroll in private plans, including stand-alone prescription drug plans (PDPs) to supplement traditional Medicare and Medicare Advantage prescription drug plans (MA-PDs) that include drug coverage and other Medicare-covered benefits. This brief analyzes Medicare Part D enrollment and costs in 2025 and trends over time, based on data from the…

  • The Bigger Story, and Agenda, Behind GOP Changes to Obamacare, Medicare and Medicaid

    From Drew Altman

    This column was published as a Wall Street Journal Think Tank column on November 21, 2016. Early media coverage of the Republican health-care agenda has concentrated on plans to repeal and then replace the Affordable Care Act. The larger story is GOP preparations for a health policy trifecta: to fundamentally change the ACA, Medicaid and Medicare–all three of health care’s major programs–and in the process, fundamentally alter the direction of the federal role in health and core elements…

  • The Impact of Part D on Dual Eligibles Who Spend-Down to Medicaid

    Issue Brief

    Individuals with incomes exceeding thresholds for regular Medicaid eligibility may qualify under state medically needy programs by spending down excess income on healthcare services. For the vulnerable population of Medicare beneficiaries who spend down to Medicaid, the Part D transition has added additional complexities that may result in disruptions in pharmacy coverage and add financial burdens. This paper explores the inter-relationship of Medicare prescription drug coverage and Medicaid spend-down for the medically needy. It describes…

  • The Role of State Pharmaceutical Assistance Programs in Serving Low-Income Medicare Beneficiaries Following the Implementation of Medicare Part D

    Issue Brief

    The Role of State Pharmaceutical Assistance Programs in Serving Low-Income Medicare Beneficiaries Following the Implementation of Medicare Part D Prior to January 1, 2006, State Pharmaceutical Assistance Programs helped to fill a critical gap in coverage for Medicare beneficiaries without prescription drug coverage, targeting resources to beneficiaries with relatively low incomes. With the inception of the Medicare prescription drug benefit, the role of SPAPs began to change. This policy brief examines the role of state…

  • Voices of Beneficiaries: Attitudes Toward Medicare Part D Open Enrollment for 2008

    Other Post

    This report focuses on the recent experiences of a group of 35 Medicare beneficiaries in the early years of the Medicare prescription drug benefit, including a number who were enrolled in a Medicare Part D drug plan in 2007. It looks at their attitudes about the open enrollment season for 2008, and their interest related to switching to a new Part D plan for 2008. It finds that most enrollees do not intend to reexamine…