How Do Dual-Eligible Individuals Get Their Medicare Coverage? July 31, 2023 Issue Brief People who are dually eligible for both Medicare and Medicaid coverage can get their Medicare coverage in a variety of ways. The brief breaks out the data for traditional Medicare, Medicare Advantage plans that are available to all Medicare beneficiaries, and plans that are designed specifically for dual-eligible beneficiaries.
A New Use for Wegovy Opens the Door to Medicare Coverage for Millions of People with Obesity April 24, 2024 Issue Brief The FDA recently approved a new use for Wegovy, the blockbuster anti-obesity drug, to reduce the risk of heart attacks and stroke in people with cardiovascular disease who are overweight or obese – a decision that opens the door to Medicare coverage of Wegovy, which is prohibited by law from covering drugs used for obesity. This brief analyses how many Medicare beneficiaries could be eligible for the new use of Wegovy and the potential impact on Medicare spending.
An Estimated 1 in 4 Medicare Beneficiaries With Obesity or Overweight Could Be Eligible for Medicare Coverage of Wegovy, an Anti-Obesity Drug, to Reduce Heart Risk April 24, 2024 News Release In a new analysis, KFF finds that 3.6 million people with Medicare could be eligible for coverage of Wegovy (semaglutide) now that the Food and Drug Administration has approved the use of the anti-obesity drug to reduce the risk of heart attacks and stroke in certain patients. This change potentially…
10 Key Facts About Women with Medicare April 30, 2024 Issue Brief This brief examines 10 key facts about women with Medicare and presents new statistics on the health, economic and functional status of women with Medicare.
Final Prior Authorization Rules Look to Streamline the Process, but Issues Remain May 2, 2024 Issue Brief This brief examines the final CMS regulations governing prior authorization in Medicare Advantage, Marketplace, Medicaid, and other plans, how they might address some current consumer concerns, and some issues that remain.
Gaps in Medicare Advantage Data Remain Despite CMS Actions to Increase Transparency April 10, 2024 Issue Brief The Centers for Medicare and Medicaid Services has recently taken actions to increase transparency in Medicare Advantage, however substantial data gaps remain that limit the ability of policymakers and researchers to conduct oversight and assess the program’s performance, and for Medicare beneficiaries to compare Medicare Advantage plans offered in their area.
FAQs on Medicare Financing and Trust Fund Solvency May 29, 2024 Issue Brief In discussions of Medicare’s financial condition, attention frequently centers on one specific measure—the solvency of the Medicare Hospital Insurance (HI) trust fund, out of which Medicare Part A benefits are paid. Based on current projections from the Medicare Board of Trustees, the HI trust fund is projected to be depleted in 2036, 12 years from now. These FAQs answer key questions about Medicare financing and trust fund solvency.
Health Insurer Financial Performance in 2023 July 2, 2024 Issue Brief Using health insurer financial data for 2023, we find that in 2023, per enrollee gross margins were highest in the Medicare Advantage market, and medical loss ratios were lowest in the individual insurance market. Across most markets, gross margins have been relatively stable in recent years.
In 2024, A Majority of States Offer Medicare Advantage Plans to Their State Retirees, with 13 Offering Medicare Advantage Exclusively July 2, 2024 Issue Brief This analysis examines the extent to which states are providing health benefits to their Medicare-eligible retirees through Medicare Advantage arrangements. In 2024, a majority of states offer Medicare Advantage plans to their state retirees, with 12 offering Medicare Advantage exclusively.
Medicare Advantage Has Become More Popular Among the Shrinking Share of Employers That Offer Retiree Health Benefits December 15, 2023 Issue Brief This analysis examines the extent to which large private and non-federal public employers that offer retiree health benefits are turning to Medicare Advantage and why they are making this shift, using data from the 2023 Employer Health Benefits Survey. We find that half (52%) of large employers offering retiree health benefits to Medicare-age retirees offer coverage to at least some retirees through a contract with a Medicare Advantage plan, double the share in 2017 (26%).