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.

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.

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  • Medicare Advantage Plans Denied 2 Million Prior Authorization Requests in 2021, About 6% of Such Requests

    News Release

    Medicare Advantage plans denied two million prior authorization requests for health care services in whole or in part in 2021, or about six percent of the 35 million requests submitted on behalf of enrollees that year, a new KFF analysis finds. Prior authorization is intended to ensure that health care services are medically necessary by requiring providers to obtain approval before a service or other benefit is covered. While prior authorization has long been used…

  • A Review of 62 Studies Finds Few Big Differences Between Traditional Medicare and Medicare Advantage on a Variety of Measures

    News Release

    With the Medicare open enrollment period set to begin Oct. 15, a perennial decision faced by Medicare beneficiaries is whether to get their coverage through traditional Medicare or the private plans known as Medicare Advantage. A new KFF review of 62 studies published since 2016 that compares Medicare Advantage and traditional Medicare on measures of beneficiary experience, affordability, utilization, and quality finds few differences that are supported by strong evidence or have been replicated across…

  • The Growth in Share of Medicare Advantage Spending

    Feature

    Earlier this week, the Biden Administration announced the final Medicare Advantage rates for 2023, which are projected to result in an average increase in Medicare Advantage plan revenue of 8.5% compared to 2022 - the highest average expected increase in recent years. Payments to Medicare Advantage plans as a share of total Medicare spending on Part A and Part B services have increased from 26% in 2010 to 45% in 2020, and are expected to…

  • Analysis: The Vast Majority of Physicians Accept New Patients, Including Patients With Medicare and Private Insurance

    News Release

    Despite occasional anecdotal reports of people having trouble finding a doctor who takes their insurance, KFF researchers find in a new analysis that the vast majority of non-pediatric office-based physicians accept new Medicare patients, as well as new private insurance patients. Eighty-nine percent of such physicians accepted new Medicare patients in 2019, and 91 percent accepted new private insurance patients, according to the analysis, which uses data from the federal 2019 National Electronic Health Records…

  • Changes to Medicare Part D in 2024 and 2025 Under the Inflation Reduction Act and How Enrollees Will Benefit

    Issue Brief

    The Inflation Reduction Act of 2022 includes several provisions to lower prescription drug costs for people with Medicare and reduce drug spending by the federal government, including a number of changes to the Medicare Part D drug benefit. This brief provides an overview of the Part D benefit design and Part D enrollee cost-sharing requirements in 2023 and changes coming in 2024 and 2025.

  • Estoy inscrito en un plan Medicare Advantage, y recientemente hice planes para viajar por los Estados Unidos. ¿Mi plan brindará la misma cobertura en todos los estados que visite?

    FAQs

    No necesariamente. Deberá comunicarse con la compañía que ofrece su plan para averiguar si los beneficios están disponibles fuera del estado. Si su plan no ofrece cobertura fuera del estado, puede haber otro plan ofrecido por la misma empresa que sí lo haga, o un plan similar ofrecido por otra empresa en su área. Sin embargo, si decide cambiarse a un plan diferente, tenga en cuenta que deberá esperar hasta el Período de Inscripción abierta…

  • Decidí no inscribirme en un plan de medicamentos de la Parte D cuando califiqué por primera vez para Medicare al cumplir 65 el año pasado, pero ahora quiero inscribirme en un plan de medicamentos durant...

    FAQs

    Sí, puede inscribirse en un plan de la Parte D durante el Período de Inscripción abierta de Medicare. Sin embargo, es posible que también deba una multa por inscripción tardía porque no se inscribió en la cobertura de medicamentos de la Parte D cuando se volvió elegible por primera vez para Medicare. La multa es igual al 1% del monto de la prima promedio nacional por cada mes que no tuvo una cobertura tan buena…

  • Medicare Advantage Hospital Networks: How Much Do They Vary?

    Report

    This report takes an in-depth look at Medicare Advantage plans’ hospital networks. The analysis draws upon data from 409 Medicare Advantage plans serving beneficiaries in 20 diverse counties that together accounted for about one in seven (14%) Medicare Advantage enrollees nationwide in 2015. The report examines the size and composition of plans’ hospital networks, the variation across counties, the inclusion of Academic Medical Centers and NCI-Designated Cancer Centers, and the relationship between network size and…