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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  • What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid

    Issue Brief

    This brief describes current coverage of GLP-1s in Medicare and Medicaid, the Centers for Medicare & Medicaid Services’ (CMS) efforts to expand access and lower costs for GLP-1s through temporary demonstration programs including the BALANCE Model, and potential impacts on beneficiaries and program budgets.

  • Implementation Dates for 2025 Budget Reconciliation Law

    Feature

    This searchable timeline shows the implementation dates for the health care provisions included in the 2025 federal budget reconciliation law, previously known as "One Big Beautiful Bill Act." It includes provisions related to Medicaid, the Affordable Care Act, Medicare and Health Savings Accounts (HSAs).

  • Tracking the Medicare Provisions in the 2025 Budget Bill 

    Other Post

    Health Provisions in the 2025 Federal Budget Reconciliation Bill Medicaid The Affordable Care Act Medicare Health Savings Accounts Updated: July 8, 2025 In addition to the changes included in the law, if Congress takes no further action, the increase in the deficit would trigger mandatory spending cuts, also known as sequestration, under the Statutory Pay-As-You-Go Act of 2010. These cuts would total approximately $500 billion to Medicare over 2026–2034, according to the Congressional Budget Office, based on…

  • Bar chart shows the estimated 10-year federal spending reductions from delaying implementation of the Biden administration's Medicare Savings Program rule and the Eligibility and Enrollment rule. Delaying these two Medicaid eligibility rules will cut federal spending by $122 billion and increase the uninsured by 400,000 over ten years

    The Impact of H.R. 1 on Two Medicaid Eligibility Rules

    Issue Brief

    This issue brief describes the impact of H.R.1's 10-year delay in implementing provisions in two Medicaid eligibility rules that would have reduced red tape. The delayed rules are projected to decrease federal spending and future Medicaid and CHIP enrollment and increase coverage loss.

  • The Role of SHIPs in Helping People with Medicare Navigate Their Coverage

    Issue Brief

    The State Health Insurance Assistance Program (SHIP) offers free counseling to help millions of Medicare beneficiaries make decisions about coverage. However, federal funding has been modest over the last decade, and federal administration of the program appears to be in transition.

  • Reading the Stars: Nursing Home Quality Star Ratings, Nationally and by State

    Issue Brief

    This issue brief presents national and state-level analysis of nursing homes based on the Five-Star Quality Rating System, recently updated by the Centers for Medicare and Medicaid Services (CMS) to help consumers compare nursing homes when selecting one for themselves or their family members. The issue brief finds that more than one-third (36%) of the nation’s 15,500 nursing homes certified by Medicare or Medicaid received relatively low ratings of 1 or 2 stars (out of…