Medicare

New & Noteworthy
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.

Related: FAQs on Medicare Financing and Trust Fund Solvency

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  • Prior Authorization in Medicare Advantage Plans: How Often Is It Used?

    Issue Brief

    Medicare Advantage enrollees are encouraged to select their plan based on a number of factors, including premiums, cost-sharing, extra benefits, drug coverage, quality of care, and provider networks, but a potentially overlooked factor is access to covered services and the potential impact of prior authorization requirements. In this data note, we examine the share of Medicare Advantage enrollees that are in plans requiring prior authorization and approval before covering the costs of services.

  • 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 prescription drug coverage but also for the viability of traditional Medicare as an option vis a vis Medicare Advantage.

  • Medicare Advantage Payments to Increase Again

    Quick Take

    The increase translates into an additional $35 billion to Medicare Advantage plans in 2026 compared to this year….The increase in payments is larger than for 2025 (3.7%) or 2024 (3.3%), but below the increase for 2023 (8.5%), and comes at a time of increasing scrutiny over Medicare Advantage payments.

  • Summary of the Affordable Care Act

    Fact Sheet

    This document summarizes the comprehensive 2010 health reform law, often called the Affordable Care Act or ACA, including changes made to it by subsequent legislation, with a focus on provisions to expand coverage, control costs, and improve delivery systems.

  • Medicare and Low-Income Beneficiaries

    Fact Sheet

    As part of The Faces of Medicare, a collection of fact sheets profiling the characteristics and health needs of different groups of Medicare beneficiaries, highlights key facts about Medicare's low-income population, who have have greater health needs than those with higher incomes.

  • Profiles of Disability: Employment and Health Coverage

    Report

    This Background Paper presents information on the disabled population, as well as alternative definitions of disability and the resulting impact on population estimates of the disabled population.

  • Health News Index–May/June 2000

    Poll Finding

    Health News Index May/June, 2000 The May/June 2000 edition of the Kaiser Family Foundation/Harvard School of Public Health, Health News Index includes questions about major health stories covered in the news, including questions about the Congressional Democrats' proposal to have the Medicare program cover prescription drug costs for the elderly.