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The Henry J. Kaiser Family Foundation

10 Essential Facts About Medicare and Prescription Drug Spending

Prescription drugs play an important role in medical care for 57 million seniors and people with disabilities, and account for $1 out of every $6 in Medicare spending. This series of charts presents and explains basic facts about prescription drug spending specifically within the context of Medicare. These 10 charts include information on current and projected Medicare prescription drug spending, out-of-pocket prescription drug costs for beneficiaries, the effects of the closing Part D “doughnut hole” and introduction of costly specialty drugs on beneficiary costs, and public opinion on prescription drug-related policy options.

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The Henry J. Kaiser Family Foundation

Modifying Traditional Medicare’s Benefit Design Could Reduce Federal Spending But With Cost Tradeoffs Between Beneficiaries and The Federal Government

Revamping traditional Medicare’s benefit design and restricting “first-dollar” supplemental coverage could reduce federal spending, simplify cost sharing, protect against high medical costs, decrease out-of-pocket spending for many beneficiaries, and provide more help to those with low incomes — but would be unlikely to achieve all of these goals simultaneously.

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The Henry J. Kaiser Family Foundation

Modifying Medicare’s Benefit Design: What’s the Impact on Beneficiaries and Spending?

This report examines an approach to reforming Medicare that has been a focus of Congressional hearings and featured in several broader debt reduction and entitlement reform proposals, and was included in the June 2016 House Republican health plan. The analysis models four different options for modifying Medicare’s benefit design, all of which include a single deductible, modified cost-sharing requirements, a new cost-sharing limit, and a prohibition on first-dollar Medigap coverage. The analysis models the expected effects on out-of-pocket spending by beneficiaries in traditional Medicare, and assesses how each option is expected to affect spending by the federal government, state Medicaid programs, employers, and other payers, assuming full implementation in 2018.

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The Henry J. Kaiser Family Foundation

Will House Republican Health Proposal and Trustees’ Report Make Medicare a Factor in Election?

In this Wall Street Journal Think Tank column, Drew Altman discusses Medicare having a low profile this campaign season, and whether the House Republican health reform plan and Medicare trustees’ report this week will push it more into the spotlight as an issue.

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The Henry J. Kaiser Family Foundation

A Study of Medicare Advantage Plan Networks in 20 Counties Finds That Plans Include About Half of All Hospitals in Their Area 

A Kaiser Family Foundation analysis of private Medicare plan networks finds that Medicare Advantage plans include about  half of area hospitals in their network, on average, while one in five plans have no  Academic Medical Center in-network.  Among plans in an area with a National Cancer Institute-designated cancer center, more…

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The Henry J. Kaiser Family Foundation

Medicare Advantage Hospital Networks: How Much Do They Vary?

This report takes an in-depth look at Medicare Advantage plans’ hospital networks. The analysis draws upon data from 409 Medicare Advantage plans serving beneficiaries in 20 diverse counties that together accounted for about one in seven (14%) Medicare Advantage enrollees nationwide in 2015. The report examines the size and composition of plans’ hospital networks, the variation across counties, the inclusion of Academic Medical Centers and NCI-Designated Cancer Centers, and the relationship between network size and other plan features, including premiums, quality star ratings, per capita Medicare spending, parent organization, and plan tax status.

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The Henry J. Kaiser Family Foundation

Payment and Delivery System Reform in Medicare: A Primer on Medical Homes, Accountable Care Organizations, and Bundled Payments

This primer providers an overview of certain delivery system reform models that are being examined in traditional Medicare, and explains model goals, financial incentives, potential beneficiary implications, and early results with respect to Medicare spending and care quality. The primer discusses accountable care organizations, medical homes and bundled payments.

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The Henry J. Kaiser Family Foundation

Medicare Advantage

This fact sheet provides an overview of the Medicare Advantage program, describes program changes made by the new health reform law in plan participation and beneficiary enrollment, presents data on benefits and premiums, and explains changes in Medicare payments to participating plans.

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The Henry J. Kaiser Family Foundation

Medicare Advantage 2016 Spotlight: Enrollment Market Update

This Data Spotlight reviews national and state-level enrollment trends as of March 2016 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.

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The Henry J. Kaiser Family Foundation

Fading Fast: Fewer Seniors Have Retiree Health Insurance

Employer- and union-sponsored retiree health benefits have served as an important source of supplemental coverage for people on Medicare, but over time, this coverage has been eroding. This Data Note draws upon five national surveys to document the decline in retirement health insurance coverage, and discusses the implications for seniors and retiring Boomers.

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The Henry J. Kaiser Family Foundation Headquarters: 2400 Sand Hill Road, Menlo Park, CA 94025 | Phone 650-854-9400
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.