Medicare

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Decoding Medicare Advantage Coding Intensity

As officials scrutinize Medicare Advantage payments, this issue brief answers key questions about coding intensity, recent steps taken by CMS to address the impact of coding, the effects on Medicare beneficiaries, and other proposals to improve Medicare Advantage payment accuracy.

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).

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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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  • Medicare Advantage Glossary

    Feature

    This glossary serves as a guide to the sometimes arcane terms that inhabit the world of Medicare Advantage, the private plan alternative to traditional Medicare.

  • Chart Reviews Increase Payments to Medicare Advantage Insurers for 1 in 6 Enrollees

    Issue Brief

    Using Medicare Advantage encounter data, this analysis finds that 62% of Medicare Advantage enrollees have at least one chart review record and that diagnoses added from chart reviews increase payments from CMS to insurers for 17% of enrollees. The use of chart reviews varies across the largest Medicare Advantage insurers.

  • Why We Are Stuck with Prior Authorization Review

    From Drew Altman

    Prior authorization review frustrates patients and physicians, but we likely can’t just eliminate it. In his new column, President and CEO Dr. Drew Altman discusses why, and why the focus is now instead on “doing it smarter.” Altman writes: “A proposal to eliminate prior authorization altogether could be the single most tangible and popular health reform idea a candidate could make. But, in our fragmented health system, with no great way to control costs or…

  • Medicare Beneficiaries Are Not Luddites

    From Drew Altman

    In a new column, President and CEO Dr. Drew Altman discusses new KFF survey data that shows that a surprising share of older adults with Medicare are using health tech regularly, and a solid majority support many of CMS’ goals to make it more widely available. But there are also big income gaps in the use of health tech, and concerns about AI, privacy, and other barriers to rapid and more widespread adoption. “Apparently… a…

  • Medicare Advantage Provider Networks Limit Enrollees to About Half of the Physicians in Their Area That Are Available to Beneficiaries in Traditional Medicare, on Average

    News Release

    With Medicare’s annual open enrollment period underway, a new KFF analysis finds that Medicare Advantage enrollees, on average, had access to just under half (48%) of the physicians in their area who were available to people enrolled in traditional Medicare. The finding illustrates a key tradeoff for beneficiaries in choosing Medicare Advantage.  Such plans can be appealing to beneficiaries because they offer extra benefits and cap out-of-pocket costs without the need for supplemental coverage. But…