Medicare

NEW AND NOTEWORTHY

What to Know About Medicare Coverage of Telehealth

Congress has repeatedly extended pandemic-era flexibilities around Medicare coverage of telehealth, but most such flexibilities remain temporary. This brief answers key questions about the current scope of Medicare telehealth coverage, including both temporary and permanent changes adopted through legislation and regulation, and future policy considerations.

Changes to the Medicare Advantage Program Enhance Some Consumer Protections But Roll Back Others

CMS recently finalized policies as part of the 2027 Medicare Advantage final rule that both enhance consumer protections and roll back changes to the Medicare Advantage program that were intended to protect consumers. These changes have gotten less attention than payment issues and changes to the star ratings system, which also affect plan payments, but could have implications for Medicare beneficiaries.

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. u003cbru003eu003cbru003eExplore 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.u003cbru003eu003cbru003eu003ca href=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022 data-type=u0022linku0022 data-id=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022u003eRelated:u003ca href=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022u003e FAQs on Medicare Financing and Trust Fund Solvencyu003c/au003eu003c/au003e

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  • Retiree Health VEBAs: A New Twist On An Old Paradigm

    Issue Brief

    This issue brief provides an overview of stand-alone Voluntary Employees' Beneficiary Association trusts, through which employers have been able to rid themselves of future obligations to pay retiree health benefits in exchange for making a significant payment to designed to approximate the projected cost of these benefits. The paper include three case studies, including the VEBAs at the Big Three automakers. Issue Brief (.pdf)

  • Medicare Part D 2009 Data Spotlight: Ten Most Common Brand-Name Drugs

    Issue Brief

    This Data Spotlight focuses on Part D plan coverage of the ten brand-name drugs that were most commonly prescribed for Medicare beneficiaries in 2006 and lack generic equivalents in 2009. Findings are based on an analysis of data for the 44 unique, national and near-national stand-alone prescription drug plans. The list of the top ten brand-name drugs is based on the number of prescriptions filled in 2006 in all Part D plans. The list includes…

  • Medicare Part D Spotlight: Part D Plan Availability in 2010 and Key Changes Since 2006

    Issue Brief

    This Medicare Part D data spotlight examines the stand-alone Medicare drug plan options that will be available to beneficiaries in 2010, including the number of available plans, premiums for those plans, and benefit designs. About two-thirds of the nearly 27 million Medicare beneficiaries who are enrolled in Part D plans get their coverage through stand-alone plans. The analysis is based on the 2010 Medicare drug plan information released by the Centers for Medicare & Medicaid Services…

  • Medicare Part D 2010 Data Spotlight: A Comparison of PDPs Offering Basic and Enhanced Benefits

    Report

    This Part D Data Spotlight examines key differences between basic and enhanced Medicare stand-alone prescription drug plans (PDPs), including monthly premiums, cost sharing, and gap coverage. It also examines plan names to assess whether they convey meaningful differences between basic and enhanced PDPs. Companies that sponsor Medicare Part D prescription drug plans are required to offer a basic benefit, either the standard Part D benefit defined by law or an actuarially equivalent benefit design. Plan…

  • Explaining Health Care Reform: Key Changes to the Medicare Part D Drug Benefit Coverage Gap

    Issue Brief

    On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act into law. The health reform law, as modified by the Health Care and Education Reconciliation Act of 2010 which passed the House of Representatives on March 21, 2010 and is under consideration in the Senate, makes several key changes to the Medicare Part D drug benefit to reduce Part D enrollees’ out-of-pocket liability when they reach the coverage gap, known as…

  • Briefing Examines High Medicare Spending for Beneficiaries in Long-Term Care

    Event Date:
    Event

    These three reports examine the relatively high use of hospital and other Medicare-covered services and the associated costs of medical care for Medicare beneficiaries who live in nursing homes and other long-term-care facilities. They also explore the potential for delivery system reforms to improve quality and reduce costs. Medicare Spending and Use of Medical Services for Beneficiaries in Nursing Homes and Other Long-Term Care Facilities: A Potential for Achieving Medicare Savings and Improving the Quality…

  • A Primer on Dually Eligible Beneficiaries

    Event Date:
    Event

    The nine million dually eligible beneficiaries are generally poorer and sicker than other Medicare beneficiaries, tend to use more health care services, and thus account for a disproportionate share of Medicare and Medicaid spending. Because they often have complex medical and long-term care needs, and must navigate both Medicaid and Medicare benefits and financing, they present a special challenge for those seeking a more efficient and coordinated care delivery system. The panel will address such…

  • Analysis of Medicare Prescription Drug Plans In 2012 And Key Trends Since 2006

    Report

    This report presents findings from an analysis of the Medicare Part D marketplace in 2012 and changes in drug coverage and costs since 2006. It presents key findings related to Medicare drug plan plan availability, premiums, cost-sharing, the coverage gap and availability for low-income beneficiaries, the coverage gap, benefit design and cost sharing, formularies, and utilization management, based on data from CMS for all plans participating in Part D. The analysis was conducted jointly by…