Insulin Costs and Coverage in Medicare Part D June 4, 2020 Issue Brief In light of heightened attention to insulin and the Trump Administration’s new Part D model to address out-of-pocket costs for insulin for Medicare beneficiaries, we analyzed out-of-pocket spending on insulin by beneficiaries enrolled in Part D drug plans, variation in Part D plan formulary coverage and tier placement of insulin products, and trends in prices for insulin.
State Medicaid Management of Prescription Drugs for HIV Treatment and Prevention June 4, 2020 Issue Brief This data note, primarily based on a survey of state Medicaid pharmacies, reviews cost-containment policies and protections as they relate to antiretrovirals for treatment and prevention of HIV.
Many Medicare Beneficiaries Face High Out-of-Pocket Costs for Dental and Hearing Care, Whether in Traditional Medicare or Medicare Advantage September 21, 2021 News Release Many Medicare beneficiaries face high annual out-of-pocket costs for dental and hearing care — services that generally aren’t covered in traditional Medicare, but typically are covered by Medicare Advantage plans though the scope and value of these benefits vary, finds a new KFF analysis. The analysis shows that, among beneficiaries…
Dental, Hearing, and Vision Costs and Coverage Among Medicare Beneficiaries in Traditional Medicare and Medicare Advantage September 21, 2021 Issue Brief This analysis builds on our prior work – Medicare and Dental Coverage: A Closer Look – by analyzing hearing and vision use, out-of-pocket spending and cost-related barriers to care among Medicare beneficiaries as well as hearing and vision benefits in Medicare Advantage plans. It also incorporates top-level findings from the analysis of dental services to provide a comprehensive profile of dental, hearing, and vision benefits in Medicare.
Key Facts About Medicare Part D Enrollment, Premiums, and Cost Sharing in 2021 June 8, 2021 Issue Brief The Medicare Part D program provides an outpatient prescription drug benefit to older adults and people with long-term disabilities in Medicare who enroll in private plans, including stand-alone drug plans and Medicare Advantage drug plans. This analysis provides the latest data about Part D enrollment, premiums, and cost sharing in 2021 and trends over time.
Potential Implications of Policy Changes in Medicaid Drug Purchasing May 4, 2021 Issue Brief This brief examines how leading federal and state policy options related to changes in Medicaid Drug Rebate Program (MDRP), drug pricing, and payment and management of the Medicaid prescription drug would affect state and federal governments as well as private industry (including drug manufacturers, managed care organizations, and pharmacies).
Financial Performance of Medicare Advantage, Individual, and Group Health Insurance Markets August 5, 2019 Issue Brief Three key private health insurance markets — Medicare Advantage, the individual market and the fully-insured group market — appear to be financially healthy and attractive to insurers. The private Medicare Advantage market generates significantly larger gross margins per person than the individual market or fully-insured market. The future of these markets has become a focus for policymakers amid the debate over Medicare for All.
How Will The Medicare Part D Benefit Change Under Current Law and Leading Proposals? October 11, 2019 Issue Brief This brief describes how the Medicare Part D benefit will change in 2020 under current law and proposed changes that would affect what beneficiaries, plans, manufacturers, and Medicare pay for drug costs under Part D in the future.
Do People Who Sign Up for Medicare Advantage Plans Have Lower Medicare Spending? May 7, 2019 Issue Brief The analysis finds that people who switched from traditional Medicare to Medicare Advantage in 2016 had health spending in 2015 that was $1,253 less, on average, than the average spending for beneficiaries who remained in traditional Medicare (after adjusting for health risk). The findings suggest that the current payment method may systematically overestimate expected costs of Medicare Advantage enrollees. Adjusting payments to reflect Medicare Advantage enrollees’ prior use of health services could potentially lower total Medicare spending by billions of dollars over a decade.
What Percent of New Medicare Beneficiaries Are Enrolling in Medicare Advantage? June 6, 2019 Issue Brief The analysis examines enrollment in Medicare Advantage plans during beneficiaries’ first year on Medicare and finds that less than one-third or 29% enrolled in these private health plans, including HMOs or PPOs. The majority of people new to Medicare are choosing traditional Medicare in the year they first go on Medicare. The study looks at how these findings vary across age, Medicaid status, states, and counties.