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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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  • Medicare Part D Spending on the EpiPen Increased More than 1000 Percent from 2007 to 2014

    News Release

    As policymakers in Washington scrutinize the rising cost of the EpiPen auto-injector, a new analysis from the Kaiser Family Foundation shows that Medicare Part D spending for the potentially life-saving device increased by more than 1000 percent between 2007, the year after the Part D drug benefit took effect, and 2014, the most recent year for which data are available. The higher spending partly results from more Part D enrollees using EpiPens during that period,…

  • Policy Insight Examines How Current Rules May Deter Seniors From Switching from Medicare Advantage to Traditional Medicare and Implications for Medicare’s Future

    News Release

    In this new policy insight, the Kaiser Family Foundation’s Tricia Neuman examines current rules that may discourage seniors from switching from Medicare Advantage to traditional Medicare.Traditional Medicare…Disadvantaged? explores this issue through the lens of a 67-year old Boomer who faced difficult financial and health coverage choices in the aftermath of a serious mountain biking accident. Previous columns in the Policy Insights series are also available.

  • Medicare Payment System Reforms: What Do We Know?

    Event Date:
    Event

    Medicare is testing new ways to pay for medical services, emphasizing value rather than volume, and evidence is beginning to build about successes and challenges. On Monday, April 11, the Kaiser Family Foundation (KFF) and the Alliance for Health Reform will host a briefing to examine what we know so far about the basic models, savings, quality, the impact on patients and the prospects for replication. Moderated by KFF’s Tricia Neuman and the Alliance’s Marilyn Serafini, Monday's discussion will…

  • Paying a Visit to the Doctor: Current Financial Protections for Medicare Patients When Receiving Physician Services

    Issue Brief

    This issue brief explains provisions in current law that shield beneficiaries from unexpected and confusing charges when they see physicians and practitioners—namely, the participating provider program, limitation on balance billing, and conditions on private contracting for doctors who opt out of Medicare or join “concierge” practices. It also analyzes the implications of modifying these provisions for beneficiaries, providers, and the Medicare program.

  • Retiree Health Benefits At the Crossroads

    Report

    This issue brief reviews recent trends and developments in employer-sponsored retiree health coverage and examines the impact of recent legislation, such as the Medicare drug benefit and the Affordable Care Act (ACA) on retiree health coverage. The report describes leading strategies employers have been pursuing or considering to limit costs for retiree health benefits. In addition, the report considers the potential implications of proposals aimed at reducing federal spending for retiree health coverage and costs.

  • Report Examines Current Role and Future Outlook of Retiree Health Coverage

    News Release

    A new Kaiser Family Foundation report examines the current role and future outlook of employer-sponsored retiree health benefits for pre-65 and Medicare-eligible retirees. Retiree Health Benefits At the Crossroads reviews recent trends and developments in employer-sponsored retiree health coverage and examines the impact of recent legislation, such as the Medicare drug benefit and the Affordable Care Act, on retiree health coverage. The report describes leading strategies employers have been pursuing to limit costs associated with…

  • Medicare Advantage: Take Another Look 

    News Release

    In the latest post in the Policy Insights series, Tricia Neuman and Gretchen Jacobson examine the surprising growth in Medicare Advantage enrollment following payment reductions included in the Affordable Care Act. Previous columns in the Policy Insights series are also available on kff.org.

  • The Policy Implications of Medicare’s New Measure of Financial Health

    Issue Brief

    This report examines a new measure of Medicare’s financial health established by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). The report, authored by Marilyn Moon, takes an in-depth look at the program’s new solvency test, which measures general revenues as a share of total Medicare spending and can trigger a “funding warning” that compels the President to propose and the Congress to consider a funding warning.

  • Medicare Advantage 2015 Spotlight: Enrollment Market Update

    Issue Brief

    This Data Spotlight reviews national and state-level enrollment trends as of March 2015 and examines variation in enrollment by plan type and firm. It analyzes the most recent data on premiums, out-of-pocket limits, Part D cost-sharing for drugs, and plans’ quality ratings for Medicare Advantage enrollees.

  • Data Note: Medicare Advantage Enrollment, by Firm, 2015

    Issue Brief

    A number of potential mergers and acquisitions between large firms that offer health insurance have been reported in the press. These mergers could affect consumers in the individual market, enrollees in the new federal and state Marketplaces, employees with employer-sponsored insurance, as well as people covered by public programs such as Medicare. This Data Note examines the Medicare Advantage market share of large firms that have reportedly engaged in merger and acquisition discussions: Aetna, Anthem,…