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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 Procurement and the Federal Budget

    Issue Brief

    This brief commissioned by the Foundation considers areas where Medicare faces limited opportunity for market-based competition and price negotiation to drive down drug spending. These areas include drug purchasing for low-income people enrolled in Part D plans who face minimal cost-sharing requirements, and purchasing certain unique drugs, such as biologicals, that have no therapeutic alternatives or competitors. Authored by Richard G. Frank of Harvard University, the brief discusses policy options that could lower Medicare spending…

  • Medicare Part D 2008 Data Spotlight: Benefit Design

    Issue Brief

    This Medicare Part D data spotlight examines the benefit design of Medicare Part D Prescription Drug Plans (PDP) in 2008, focusing on national plans. It shows that in 2008, as in previous years, only about 10 percent of national prescription drug plans offered the defined standard benefit. The spotlight also looks at cost sharing structures, the use of flat dollar copayments, the upward trend in cost sharing for non-preferred drugs, and recent changes in cost…

  • Prescription Drug Spending Under The MMA: Modeling The Impact On Out-of-Pocket Costs

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    This report projects the impact of the new Medicare drug benefit on out-of-pocket spending for people who enroll in 2006. The analysis is based on a model developed by the Actuarial Research Corporation for the Kaiser Family Foundation. The model generally conforms to the Congressional Budget Office’s assumptions and projections about Medicare drug benefit spending and participation rates for the new benefit and for the low-income subsidy. The report was released at a briefing in…

  • Medicare Part D 2009 Data Spotlight: The Coverage Gap

    Report

    This Medicare Part D data spotlight examines the coverage gap, or "doughnut hole," in Medicare drug plans available in 2009. While in the gap in coverage, Part D enrollees (other than those receiving low-income subsidies) are required to pay 100 percent of total drug costs until they reach the catastrophic coverage level. In 2009, nearly all Part D plans have a coverage gap, though one in four plans offer limited coverage in the gap --…

  • Low-Income Medicare Beneficiaries: How the House and Senate Prescription Drug Bills Address Their Drug Needs

    Report

    The House and Senate versions of a Medicare prescription drug bill treat the drug costs of those dually-eligible for Medicare and Medicaid and other low-income Medicare beneficiaries quite differently. The Kaiser Commission on Medicaid and the Uninsured cosponsored a policy briefing on the key issues in the two bills that would impact low-income beneficiaries and released a brief and background report on the topic. A Prescription Drug Benefit in Medicare: Implications for Medicaid and Low-Income…

  • 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…

  • The Value of Extra Benefits Offered by Medicare Advantage Plans in 2006

    Report

    The Value of Extra Benefits Offered by Medicare Advantage Plans in 2006 As Medicare Advantage enrollment continues to climb, this report prepared for the Kaiser Family Foundation compares the value of extra benefits provided by private fee-for-service and other types of Medicare Advantage plans. As of January 2008, 8.8 million people with Medicare were enrolled in a Medicare Advantage plan, an increase of 63% since 2005. Some say the recent growth in Medicare Advantage enrollment…

  • Medicare and the President’s Fiscal Year 2009 Budget Proposal

    Fact Sheet

    Medicare and the President's Fiscal Year 2009 Budget Proposal This fact sheet summarizes key Medicare-related provisions in the Bush Administration's fiscal year 2009 budget proposal, as well as additional legislation that responds to the Medicare Trustees' "Medicare Funding Warning." Fact Sheet (.pdf)

  • The Role of Private Plans in Medicare

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    Enrollment in private health plans has grown sharply since the enactment of the Medicare Modernization Act in 2003, which created a Medicare drug benefit to be provided by private plans and created incentives for new private plans to enter the Medicare market. Today, virtually all Medicare beneficiaries--including those living in rural areas--have access to one or more private plans (known as Medicare Advantage plans), such as a Medicare HMO, PPO, special-needs plan or a private…

  • Medicaid Matters For Low Income Medicare Beneficiaries: A Video

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    In this video, Mildred Benham, a 68 year-old dual enrollee who lives in Bloomington, Illinois, describes the role Medicaid plays in providing services that Medicare does not, such as prescription drugs and personal care. Mildred is a typical dual enrollee in that she has multiple conditions, such as fibrosis of the lungs, rheumatoid arthritis, high blood pressure, and cataracts. To control her conditions, she takes 12 prescriptions a day. Because of her physical limitations, Medicaid…