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.

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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  • Why Medicare’s Aduhelm Coverage Decision Could Increase Pressure on Officials to Roll Back the Record Part B Premium Increase for 2022

    News Release

    In a new Policy Watch, KFF experts explain why Medicare’s preliminary decision to cover a new Alzheimer’s drug only for a limited group of beneficiaries is likely to intensify pressure on officials to reconsider the increase in the Medicare Part B premium for 2022. Earlier this week, CMS issued a preliminary National Coverage Determination that would limit coverage of the new drug, Aduhelm, to beneficiaries with mild cognitive impairment who participate in approved clinical trials…

  • What’s the Latest on Medicare Drug Price Negotiations?

    Issue Brief

    In response to prescription drug spending growth and heightened attention to drug prices, some policymakers have proposed allowing the federal government to negotiate the price of prescription drugs for Medicare and private payers. This brief describes the current status of drug price negotiation proposals, looks back at the history of proposals to give the federal government the authority to negotiate drug prices in Medicare, describes the negotiation provisions in key legislation (H.R. 3), and discusses…

  • Deaths From COVID-19 Spiked Over The Summer, Especially Among People 65 and Older, Before Dipping Again in September

    News Release

    Although COVID-19 fatalities remain much lower than during the peak of last winter’s Omicron surge, deaths among people 65 and older spiked over the summer, more than doubling between April and July 2022, finds a new KFF analysis. The number of deaths topped more than 11,000 people 65 and older in both July and August. For people younger than 65, deaths have increased more slowly since April, rising by 52 percent to about 1,900 in…

  • Summary of Costs and Impact of the Prescription Drug Provisions in the Build Back Better Act

    News Release

    As the House-passed Build Back Better Act moves to the Senate, a new explainer from KFF summarizes the key prescription drug provisions within the broader budget reconciliation bill. These provisions would lower prescription drug costs paid by people with Medicare and private insurance and curb drug spending by the federal government and private payers. The Congressional Budget Office estimates federal budget savings from the drug pricing provisions would be $297 billion over 10 years. Although…

  • New OIG Report Examines Prior Authorization Denials in Medicaid MCOs

    Policy Watch

    Congress asked the U.S Department of Health and Human Services (HHS) Office of the Inspector General (OIG) to investigate whether Medicaid MCOs are providing medically necessary health care services to their enrollees. OIG found that Medicaid MCOs had an overall prior authorization denial rate of 12.5%–more than 2 times higher than the Medicare Advantage rate. Prior authorization denial rates ranged widely across and within parent firms and states. After a prior authorization request is denied,…

  • KFF Health Tracking Poll July 2023: The Public’s Views Of New Prescription Weight Loss Drugs And Prescription Drug Costs

    Feature

    About half of adults are interested in taking prescription weight loss drugs. though interest drops when presented with obstacles or drawbacks. Many adults struggle with affording prescription drugs and say there should be more price regulation. Few are aware of provisions in the 2023 Inflation Reduction Act aimed at lowering the drug price for Medicare beneficiaries

  • The 4 Arguments You Will Hear Against Drug Price Negotiation

    Perspective

    As the Biden administration begins the process of negotiation drug prices for Medicare as authorized in the Inflation Reduction Act, KFF's Larry Levitt probes some of the arguments against it and the policy and political implications of the debate in this New York Times op-ed column.