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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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  • Prescription Drug Sources Among Medicare Beneficiaries

    Report

    Note: Estimates are rounded to the nearest whole number, therefore do not sum to total. (1) Includes Veterans Administration, Indian Health Service, employer plans without retiree subsidies, employer plans for active workers, and state pharmaceutical assistance programs. (2) Includes employer/union, FEHB, and TRICARE coverage. (3) Approximately 0.5 million dual eligibles are enrolled in Medicare Advantage drug plans and are reported in this category. Source: HHS, January 30, 2007. Data as of January 16, 2007.

  • Private Fee-For-Service Plans In Medicare: Rapid Growth and Future Implications

    Event

    Kaiser Family Foundation Vice President Patricia Neuman, Ph.D., testified May 2007 before the House Ways and Means Subcommittee on Health on the rapid growth of private fee-for-service plans in the Medicare program and its implications for seniors and people with disabilities. Dr. Neuman is director of the Foundation's Medicare Policy Project. Testimony (.pdf)

  • An Update on CMS’s Capitated Financial Alignment Demonstration Model For Medicare-Medicaid Enrollees

    Issue Brief

    Beginning in January, 2013, the Centers for Medicare and Medicaid Services (CMS) will implement a three year multi-state demonstration to test new service delivery and payment models for people dually eligible for Medicare and Medicaid. These demonstrations will enroll full dual eligibles in managed fee-for-service or capitated managed care plans that seek to integrate benefits and align financial incentives between the two programs. On January 25, 2012, CMS issued a memorandum providing additional guidance for…

  • Best Bets for Reducing Medicare Costs for Dual Eligible Beneficiaries: Assessing the Evidence

    Report

    With pressure mounting to slow the growth in federal health care spending, policymakers are exploring ways to reform the way care is delivered to the 9 million low-income Medicare beneficiaries who also receive Medicaid – a group that on average is sicker and frailer than other Medicare beneficiaries, and therefore receive significantly more care at greater cost. Major efforts are underway at the federal and state level to better coordinate care for this population and…

  • What’s In and What’s Out? Medicare Advantage Market Entries and Exits for 2015

    Issue Brief

    This Data Note examines the availability of plans nationwide and by state in 2015, and changes in plan availability since 2011. It documents the number and share of Medicare Advantage enrollees affected by plan withdrawals each year, the characteristics of plans that will be entering the market and characteristics of those exiting the market in 2015.

  • Medicare Part D: A First Look at Plan Offerings in 2015

    Issue Brief

    This issue brief provides an overview of the Medicare Part D stand-alone prescription drug plan options available in 2015 and key changes from prior years. The analysis examines Part D plan availability, premiums, benefit design features, and low income subsidy plan availability.

  • Open Enrollment: Insights from Medicare for Health Insurance Marketplaces

    Perspective

    This Policy Insight draws on the experiences of Medicare beneficiaries during Medicare’s annual enrollment period to consider whether consumers with health insurance coverage through the Affordable Care Act’s new marketplaces will shop for a better deal during their open enrollment season.

  • Insulin Out-of-Pocket Costs in Medicare Part D

    Issue Brief

    Addressing the cost of insulin continues to be at the forefront of policy discussions around prescription drugs. This analysis describes out-of-pocket spending on insulin products by Medicare beneficiaries enrolled in Part D drug plans, along with state-level use and spending data.