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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  • Medigap May Be Elusive for Medicare Beneficiaries with Pre-Existing Conditions

    Issue Brief

    This issue brief analyzes federal and state guaranteed issue rules and how they impact beneficiaries’ access to Medigap, including the implications for Medicare beneficiaries with pre-existing conditions and those under age 65 with long-term disabilities. This brief also explores a recently finalized rule: Nondiscrimination in Health Programs and Activities regarding Section 1557 of the Affordable Care Act that may have implications for the Medigap market.

  • 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…

  • Explaining Health Care Reform: How Do Health Care Costs Vary By Region?

    Issue Brief

    Although regional variations in health spending have been studied for decades, there is renewed focus on this issue because of the role of health care costs in health care reform and the potential source of funds if addressing cost variations can yield savings. This explainer examines what is known about regional variations in health care costs and their relationship to quality of care, and addresses key questions about their role in health reform. Issue Brief…

  • Learning From History: Deinstitutionalization of People with Mental Illness As Precursor to Long-Term Care Reform

    Report

    This report examines what policy lessons can be learned from the deinstitutionalization of people with mental illnesses and applied to potential long-term care reform for the elderly or those with significant disabilities. The study assesses the reforms that took place under deinstitutionalization, their impact and what mistakes were made. It also discusses the take-away lessons for long-term care policy, with a focus on planning, financing, living situations and the role of families, workplace issues, and…

  • Prospects for Retiree Health Benefits as Medicare Drug Coverage Begins

    Poll Finding

    Findings from the Kaiser/Hewitt 2005 Survey on Retiree Health Benefits The 2005 Kaiser/Hewitt survey of large businesses that provide retiree health benefits to their workers assesses their responses to the new Medicare drug benefit in 2006, their plans for the future, and the way these changes affect retirees. It also looks at the rising costs and changing benefits of retiree health coverage overall in 2005. News Release Report Chartpack Materials from the December 7, 2005…

  • The Role of Health Coverage for People with Disabilities: Findings from 12 Focus Groups with People with Disabilities

    Report

    This report presents findings from focus groups conducted with people with a range of disabilities in an effort to understand the challenges they face and their experiences in the health-care system. To capture variations in experiences by source of health insurance, the groups include people covered under Medicare, Medicaid, and private insurance, as well as those no health insurance at all. The report highlights the ways in which various sources of insurance are working for…

  • The Implications of Medicare Prescription Drug Proposals for Employers and Retirees

    Report

    This report examines the potential savings for employers who currently represent the largest source of drug coverage for seniors. The study finds substantial savings for large employers under comprehensive Medicare prescription drug proposals ranging from $5-8.5 billion in 2003 to $10-$15 billion in 2009. It also finds that the majority of large employers are likely to retain retiree coverage, as a supplement to a Medicare drug benefit. Report

  • Medicare: The Basics, A Public Dialogue on Health Care: The Future of Medicare

    Other Post

    Medicare: The Basics Part Two A Henry J. Kaiser Family Foundation Report Coverage Under Managed Care Plans and Other Options The vast majority of Medicare beneficiaries have their health care bills paid directly by Medicare's traditional fee-for-service program. The rest-nearly 6 million people-are covered under managed care plans, mostly HMOs, which contract with Medicare. Since the mid-1980s, a growing number of beneficiaries have elected to receive the benefits covered by Medicare Parts A and B…