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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  • Help with Medicare Premium and Cost-Sharing Assistance Varies by State

    Issue Brief

    This data note provides an overview of programs that help beneficiaries with modest incomes with their Medicare costs, including the Medicare Savings Programs and the Part D Low-Income Subsidy, and highlights findings from corresponding state-level profiles of eligibility and enrollment.

  • Key Facts About Medicare Part D Enrollment and Costs in 2022

    Issue Brief

    This analysis provides the latest data about Medicare Part D enrollment, premiums, and cost sharing in 2022 and trends over time, including information about stand-alone prescription drug plans (PDPs) and Medicare Advantage prescription drug plans.

  • New Interactive Provides Essential Facts and Trends Related to Medicare Spending

    News Release

    A new KFF interactive provides essential facts and trends about spending on Medicare, the federal health insurance program that covers 65 million seniors and people with disabilities, or nearly 1 in 5 Americans. In 2020, Medicare spending accounted for 12 percent of the federal budget and 20 percent of national health care spending.

  • Insulin Out-of-Pocket Costs in Medicare Part D

    Issue Brief

    Addressing the cost of insulin continues to be at the forefront of policy discussions around prescription drugs. This analysis describes out-of-pocket spending on insulin products by Medicare beneficiaries enrolled in Part D drug plans, along with state-level use and spending data.

  • Is the Biden Administration Proposing Cuts to Medicare Advantage?

    Policy Watch

    Recent announcements by the Administration to improve the accuracy of payments and improve program integrity of Medicare Advantage are unlikely to have a major impact on the program, the insurance industry or beneficiaries, given relatively generous payments to plans and the robustness of the market for private Medicare plans.

  • Medicare Advantage Insurers Report Much Higher Gross Margins Per Enrollee Than Insurers in Other Markets

    News Release

    A new analysis of health insurers’ 2021 financial data shows that insurers continue to report much higher gross margins per enrollee in the Medicare Advantage market than in other health insurance markets. The analysis examines insurers’ financial data in the Medicare Advantage, Medicaid managed care, individual (non-group), and fully insured group (employer) markets.

  • Unpacking the Controversy Over Medicare Advantage

    Event Date:
    Event

    Medicare Advantage is the rapidly growing private plan alternative to traditional Medicare that provides coverage to approximately half of Medicare beneficiaries. On Tuesday, March 21, three experts joined series moderator Larry Levitt in a 45-minute discussion on Medicare Advantage, addressing such questions as: What has driven the growth in Medicare Advantage enrollment? What are the implications of enrollment being concentrated in a few insurance firms? Is the federal government overpaying plans? What would the new rules and proposed changes do, and how would they affect beneficiaries?