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  • Prior Authorization in Medicare Advantage Plans: How Often Is It Used?

    Issue Brief

    Medicare Advantage enrollees are encouraged to select their plan based on a number of factors, including premiums, cost-sharing, extra benefits, drug coverage, quality of care, and provider networks, but a potentially overlooked factor is access to covered services and the potential impact of prior authorization requirements. In this data note, we examine the share of Medicare Advantage enrollees that are in plans requiring prior authorization and approval before covering the costs of services.

  • Three firms Account for Over Half of All Medicare Part D Enrollees in 2018, and Pending Mergers Would Further Consolidate the Marketplace

    News Release

    In 2018, three Medicare Part D plan sponsors—UnitedHealth, Humana, and CVS Health—account for more than half of the program’s 43 million Part D enrollees (55%) and two-thirds of all stand-alone drug plan enrollees, indicating a marketplace that is dominated by a handful of major insurers, according to a new Kaiser Family Foundation analysis of Part D enrollment, premiums and cost-sharing data. The proposed mergers of CVS Health and Aetna, and Cigna and Express Scripts would…

  • New England Journal of Medicine: Medicare Advantage Checkup

    Perspective

    In this November 2018 New England Journal of Medicine article, KFF's Tricia Neuman and Gretchen Jacobson examine the extent to which Medicare Advantage plans are achieving goals with respect to benefits, out-of-pocket costs, plan choice, federal spending and quality.

  • Low-Income Subsidies for the Medicare Prescription Drug Benefit: The Impact of the Asset Test

    Report

    This study assesses the impact of the requirement that low-income people with Medicare meet an asset test in order to receive additional help paying premiums and cost-sharing under the new Medicare drug benefit. Report (.pdf) American Journal of Managed Care Article: Who Will Be Denied Medicare Prescription Drug Subsidies Because of the Asset Test? (January 2006) (.pdf)

  • Private Plans In Medicare: A 2007 Update

    Issue Brief

    This March 2007 issue brief, commissioned by the Kaiser Family Foundation, examines changes between 2006 and 2007 in the availability of and enrollment in Medicare Advantage and Medicare prescription drug plans overall and in urban and rural areas. It also focuses on the firms that are offering various types of Medicare plans. Marsha Gold of Mathematica Policy Research, Inc., prepared the brief. Issue Brief (.pdf)

  • Financial Performance of Medicare Advantage, Individual, and Group Health Insurance Markets

    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.

  • Less Than One-Third of New Medicare Beneficiaries Enrolled in Medicare Advantage During Their First Year on Medicare 

    News Release

    Twenty-nine percent of new beneficiaries chose to enroll in Medicare Advantage during their first year in Medicare in 2016, finds a new KFF analysis. That level generally matches the overall share of beneficiaries who opted for Medicare Advantage that year, but does not support the view that the aging Baby Boom generation, having had more experience with HMOs and PPOs during their working years, would select the private plans over traditional Medicare at relatively high…

  • KFF Research Shows that Medicare Open Enrollment TV Ads Are Dominated by Medicare Advantage Plans Featuring Celebrities, Active and Fit Seniors, and Promises of Savings and Extra Benefits Without Fundamental Plan Information

    News Release

    The annual blitz of ads for Medicare Advantage plans has become a rite of fall, as health insurers, brokers and other third parties seek to court enrollees for these private plans, which are offered to the 65 million people with Medicare during the program’s open enrollment season. In advance of the open enrollment period starting on October 15, KFF reviewed more than 1,200 unique television ads that aired more than 643,000 times last year to…