What Are the Prescription Drug Provisions in the Inflation Reduction Act?
This slideshow explains the prescription drug provisions proposed in the Inflation Reduction Act as passed by the Senate
This slideshow explains the prescription drug provisions proposed in the Inflation Reduction Act as passed by the Senate
The House is expected to take up the Senate-passed Inflation Reduction Act later this week, a sweeping bill that includes several landmark health care provisions that would lower prescription drug costs for people with Medicare, reduce Medicare drug spending and extend enhanced subsidies for Affordable Care Act marketplace coverage. At Noon Eastern time on Thursday,…More
This issue brief presents state-level data on Medicaid financial eligibility criteria and adoption of the major non-MAGI pathways as of January 2022. The data were collected from March through May 2022 in KFF’s survey of Medicaid state eligibility officials.
This issue brief describes anticipated enrollment changes in pathways based on old age or disability (“non-MAGI”) after the PHE ends, state enrollment and renewal policies for non-MAGI groups as of January 1, 2022, and state plans for resuming normal operations when the PHE ends.
The New York State Office for the Aging announced Wednesday that it is partnering with Intuition Robotics to bring an AI robotic care companion into the homes of 800 older adults as part of the state’s efforts to battle social isolation and support aging in place.
These FAQs provide answers to questions about Medicare’s current coverage of telehealth, changes made at the outset of the public health emergency, additional changes adopted by Congress and the Administration, and some of the policy considerations that lie ahead.
One way MA plans can stand out in an increasingly competitive market is by making members aware of the benefits they may not even know they have and encouraging them to use those benefits.
This data note presents the most recent national and state-level data on nursing facility-reported staff shortages and describes the Biden Administration’s new policy initiatives to address staffing and other quality issues in nursing facilities.
In the face of rising prescription drug costs, a large majority of the public supports federal efforts to lower drug spending. Policymakers are considering several proposals that would lower prescription drug costs. To better understand the potential out-of-pocket cost exposure that Medicare beneficiaries may face for Part B drugs, which are typically administered by physicians …
The federal government and the states together spent a total of $116 billion on Medicaid home and community-based services (HCBS) in FY 2020, serving millions of elderly adults and people with disabilities, a new KFF analysis finds. Medicaid is the nation’s primary payer for such services, which include assistive technology, personal care to help people…More
This issue brief presents FY 2020 state-level data on the number of people receiving Medicaid HCBS and HCBS spending. This is the latest data available, and the first since the onset of the COVID-19 pandemic. The data were collected in KFF’s 19th survey of state officials administering Medicaid HCBS programs in all 50 states and …
Medicaid Home & Community-Based Services: People Served and Spending During COVID-19 Read More »
This issue brief presents findings on key state policy choices about Medicaid HCBS in FY 2020. This is the latest data available, and the first since the onset of the COVID-19 pandemic. The data were collected in KFF’s 19th survey of state officials administering Medicaid HCBS programs in all 50 states and DC. A related …
State Policy Choices About Medicaid Home and Community-Based Services Amid the Pandemic Read More »
Older adults have suffered more illness and death from covid-19 than any other group. How are they faring as the pandemic enters its third year? KFF’s Kaiser Health News (KHN) and The John A. Hartford Foundation will explore that question in depth in a 90-minute interactive web event beginning at noon ET on Wednesday, Feb.…More
Older adults have suffered more illness and death from covid-19 than any other group. How are they faring as the pandemic enters its third year? KFF’s Kaiser Health News (KHN) and The John A. Hartford Foundation will explore that question in depth in a 90-minute interactive web event beginning at noon ET on Wednesday, Feb.…More
Wells Fargo Strategic Capital led the Series B funding round. Concerto also announced Thursday that it has acquired Crown Health, a home-based primary care practice serving the Pacific Northwest.
The Build Back Better Act (BBBA) includes a range of health and other proposals supported by President Biden, including a proposal to allow the federal government to negotiate the price of some prescription drugs covered under Medicare Part B (administered by physicians) and Medicare Part D (retail outpatient drugs). This brief illustrates the potential scope …
In a new Policy Watch, KFF experts explain why Medicare’s preliminary decision to cover a new Alzheimer’s drug only for a limited group of beneficiaries is likely to intensify pressure on officials to reconsider the increase in the Medicare Part B premium for 2022. Earlier this week, CMS issued a preliminary National Coverage Determination that…More
This slideshow explains the latest prescription drug provisions in the Build Back Better Act (BBBA).
As the House-passed Build Back Better Act moves to the Senate, a new explainer from KFF summarizes the key prescription drug provisions within the broader budget reconciliation bill. These provisions would lower prescription drug costs paid by people with Medicare and private insurance and curb drug spending by the federal government and private payers. The…More
The Build Back Better Act includes several provisions that would lower prescription drug costs for people with Medicare and private insurance and reduce drug spending by the federal government and private payers. This brief summarizes these provisions and discusses the expected effects on people, program spending, and drug prices and innovation.
A record 3,834 Medicare Advantage plans will be available across the country as alternatives to traditional Medicare for 2022, a new KFF analysis finds. That’s an increase of 8 percent from 2021, and the largest number of plans available in more than a decade. At the same time, the number of Medicare Part D stand-alone…More
For 2022, the average Medicare beneficiary has access to 39 Medicare Advantage plans, the largest number of options available in the last decade, and can choose from plans offered by nine firms. Among the majority of Medicare Advantage plans that cover prescription drugs, 59 percent will charge no premium in addition to the monthly Medicare …
This issue brief provides an overview of the Medicare Part D prescription drug benefit market for 2022, with a primary focus on stand-alone drug plans. It includes national and state-level data on plan availability, premiums, benefit design, cost sharing, information about premium-free plans for low-income beneficiaries, and information about the national Part D drug plans …
Medicare Part D: A First Look at Medicare Prescription Drug Plans in 2022 Read More »
The bill, if enacted into law, will establish an electronic prior authorization process and require Medicare Advantage plans to report on their use of prior authorization and the rate of approvals or denials to CMS. It has 227 co-sponsors in the U.S. House, indicating strong support from both Republicans and Democrats.
This fact sheet includes the latest information and data about the Medicare Part D prescription drug benefit, including current plan information, the standard benefit parameters, low-income assistance, the latest available enrollment data, and Part D program spending and financing.
The covid pandemic has provided more visibility for longstanding ageist attitudes and practices that run through the health care system, at times undermining the care and well-being of older adults in this country. KFF’s Kaiser Health News and The John A. Hartford Foundation will hold a 90-minute interactive web event on ageism in health care…More
This data note from the latest KFF Health Tracking Poll explores the public’s views on Medicare drug price negotiation, including how arguments on both sides impact support and opposition; confidence in leaders to do the right thing on drug pricing; and experiences with prescription drug costs.
Most of the Public Lacks Confidence that President Biden, Congressional Democrats or Republicans Will Do the Right Thing on Drug Prices Allowing the federal government to negotiate with drug companies to lower drug prices for Medicare beneficiaries and people enrolled in private plans – a key cost-saving proposal in the Democrats’ massive reconciliation bill –…More
Though the Medicare Advantage-focused insurance technology startup is smaller than rivals like Clover Health in terms of membership and revenues, this latest financing round places it ahead of, or at least on par with, several larger competitors with regard to total funds raised.
This policy watch evaluates the pharmaceutical industry’s claims that allowing the federal government to negotiate drug prices would restrict access to medications in Medicare. It explains what the current proposal to allow drug price negotiation would and wouldn’t do.
The months-long decline in COVID-19 deaths among nursing home residents and staff reversed course this summer as the Delta variant dominated, with mortality increasing five-fold from 350 deaths in July to nearly 1,800 in August, finds a new KFF analysis. The analysis also finds increases in nursing home COVID-19 cases and deaths were steeper than…More
This analysis looks at the relationship between vaccination rates and COVID-19 deaths for adults 65 and older since the Delta variant took hold, and finds that states with lower vaccination rates among adults ages 65 and older had higher death rates among older adults during this period.
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 who used each type of…More
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 …
Medicare Part D, the outpatient prescription drug benefit for Medicare beneficiaries, provides coverage above a catastrophic threshold for high out-of-pocket drug costs, but there is no cap on total out-of-pocket drug costs that beneficiaries pay each year. Recent legislative proposals would add a cap on out-of-pocket spending under Part D. This analysis focuses on the …
Through the partnership, Ochsner Health’s Medicare Advantage patients will gain access to Bold’s platform, which assesses current fitness levels to create a personalized exercise program for users.
The senior care provider currently operates 34 medical centers offering healthcare and social services, like transportation. Through the collaboration, the companies will bring more seniors into value-based arrangements with the goal of improving outcomes for Anthem patients.
Proposals to allow the federal government to negotiate prescription drug prices, such as H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act, aim to lower out-of-pocket drug costs for Medicare beneficiaries and private plan enrollees and achieve savings for Medicare. This data note estimates average premium savings attributable to the negotiations provision of …
How Would Drug Price Negotiation Affect Medicare Part D Premiums? Read More »
During the pandemic many states have experienced worsening direct care workforce shortages that have affected providers of home- and community-based long-term care services (HCBS), according to early findings of a new KFF survey of Medicaid HCBS programs in all 50 states and the District of Columbia. Most states reported workforce shortages as the pandemic’s primary…More
This issue brief presents early findings from the most recent KFF survey of Medicaid HCBS programs in all 50 states and the District of Columbia. It focuses on state policies adopted in response to challenges posed by the pandemic, the pandemic’s impact on Medicaid HCBS enrollees and providers, and states’ initial plans for the new …
These FAQs discuss recent efforts related to prescription drug importation, the history of this approach, challenges that previous efforts to carry out importation proposals have faced, and stakeholder views.
Many people enrolled in Medicare go without dental care, especially beneficiaries of color, according to a new KFF analysis of dental coverage and costs for people with Medicare. Almost half of all Medicare beneficiaries (47%) did not have a dental visit within the past year as of 2018, the analysis finds, with rates higher among…More
Medicare does not cover routine dental care and about half of Medicare beneficiaries do not have dental coverage. Some beneficiaries have dental coverage through other sources, including Medicare Advantage, but 47% of all beneficiaries have not been to the dentist in the past year and many older adults face high out-of-pocket costs for needed dental …
Nearly 3 million Medicare Part D enrollees had out-of-pocket drug spending above the catastrophic threshold in a recent five-year period, finds a new KFF analysis that takes a comprehensive look at how many people on Medicare have drug expenses high enough to push them above that limit. While the Part D drug benefit has helped…More
In response to prescription drug spending growth and heightened attention to drug prices, some policymakers have proposed allowing the federal government to negotiate the price of prescription drugs for Medicare and private payers. This brief describes the current status of drug price negotiation proposals, looks back at the history of proposals to give the federal …
What’s the Latest on Medicare Drug Price Negotiations? Read More »
Medicare Part D, the outpatient prescription drug benefit for Medicare beneficiaries, provides catastrophic coverage for high out-of-pocket drug costs, but there is no limit on the total amount that beneficiaries have to pay out of pocket each year. Policymakers on both sides of the aisle support proposals to modify the design of the Part D …
States are currently developing plans to access an increased federal matching rate (“FMAP”) for Medicaid HCBS spending established in the American Rescue Plan Act (ARPA) of 2021. In the future, states may also be able to access increased HCBS funds proposed in the Biden Administration’s American Jobs Plan and the Better Care Better Jobs Act …
State Options to Expand Medicaid HCBS: Examples & Evaluations of Section 1115 Waivers Read More »
Enrollment in Medicare Advantage plans grew rapidly between 2009 and 2018, with the largest increases seen among Black, Hispanic and dual enrollee — that is enrolled in both Medicare and Medicaid — populations. This indicates that payers will need to play a key role in addressing health inequities.
Senior-focused primary care provider Cano Health acquired Doctor’s Medical Center for $300 million, which adds around 54,000 new members and 18 medical centers to its roster. This is the second major acquisition for Cano Health in less than a month. The company bought University Health Care for $600 million in mid-June.
Main Street Health, launched by former Center for Medicare & Medicaid Innovation Director Brad Smith, aims to provide value-based care solutions in rural America. The company’s first step will be to partner with primary care clinics, urgent care centers and independent pharmacies to implement a program that will coordinate care for seniors.
Cano Health, which provides primary care services for seniors, bought Miami-based University Health Care for $600 million. University Health Care serves approximately 24,000 Medicare Advantage members, which will bring Cano Health’s membership to around 143,000.
This issue brief highlights key differences between Medicare and Medicaid and raises questions about how a policy to lower the age of Medicare eligibility could affect individuals who are currently enrolled in Medicaid.
The question of what would happen when a new, expensive prescription drug comes to market for a disease like Alzheimer’s that afflicts millions of people has loomed large in discussions over drug prices in the U.S. This brief analyzes the cost implications for Medicare and beneficiaries associated with Biogen’s new FDA-approved Alzheimer’s drug, which will …
CMS is increasing the payment for administering at-home Covid-19 vaccinations from around $40 to $75 per dose. The move comes amid the Biden administration’s push to boost vaccinations nationwide, including among older adults who may not be able to access vaccine sites.
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.
A new KFF analysis shows that lowering the age of Medicare eligibility to 60 could improve the affordability of coverage for people who are already insured and expand coverage to over a million of the nation’s 30 million uninsured. Such a policy could provide a path to Medicare coverage for up to 11.7 million people…More
This brief analyzes current experiences of Medicare beneficiaries ages 65 and older with respect to satisfaction and access measures and examines whether privately-insured adults ages 50 to 64 report access or cost problems at higher or lower rates than Medicare beneficiaries 65 and older.
Two new KFF analyses find that lowering the age of Medicare eligibility from 65 to 60 could significantly reduce health spending for employers, who could potentially pass savings to employees in the form of lower premiums or higher wages. Additionally, per person health spending for older adults who move from employer coverage on to Medicare…More
During the presidential campaign, President Biden proposed to lower the age of Medicare eligibility from 65 to 60. This analysis uses claims data for covered medical services from both large employer plans and traditional Medicare to illustrate the potential spending effects of using Medicare payment rates in lieu of higher rates paid by employer plans …
This analysis for the Peterson-KFF Health System Tracker illustrates the potential for employer savings if the age of Medicare eligibility were lowered to 60, as proposed by President Biden during the 2020 campaign.
COVID-19 deaths and cases among residents and staff of long-term care facilities have fallen dramatically since vaccinations began in December, with deaths declining by nearly 89 percent and cases declining by nearly 92 percent as of April 2021, according to a new KFF analysis. COVID-19 deaths in long-term care settings fell from 1.7 deaths per…More
This data note looks at state-reported LTCF data from 41 states plus Washington DC to assess what has happened to new deaths and cases in LTCFs in the four months since vaccinations began on December 21st, 2020. We also examine how recent changes in deaths and cases in LTCFs have shifted the nature of the …
This issue brief places the American Jobs Plan in the context of current Medicaid HCBS spending and considers how policymakers might allocate the new funding, as the proposal to date includes little detail.
The American Rescue Plan includes a provision to increase the federal matching rate (FMAP) for spending on Medicaid HCBS by 10 percentage points from April 1, 2021 through March 31, 2022 provided states maintain state spending levels as of April 1, 2021.This brief discusses the proposal and provides state by state estimates of the potential …
Members of America’s Health Insurance Plans and the Blue Cross Blue Shield Association are launching an initiative to help seniors in underserved communities get access to the Covid-19 vaccine. They aim to get 2 million Americans, older than 65, vaccinated.
Seniors in the U.S. are among the hardest hit by the Covid-19 pandemic and providing them with primary care proved to be a major challenge. But several organizations rose to the occasion, deftly changing their care delivery strategies as the pandemic evolved.
This brief takes a closer look at multiple measures beyond waiver waiting lists to evaluate state choices about optional Medicaid eligibility pathways, spending, and services for seniors and people with disabilities as of 2018. The analysis draws on several KFF resources, including 50-state surveys of Medicaid financial eligibility pathways for seniors and people with disabilities, …
Twenty-two states and the District of Columbia have vaccinated at least one-third of their residents who are 65 and older against COVID-19, an updated KFF analysis finds, but no state has crossed the threshold of vaccinating 50 percent or more of its older population. The share of adults 65 and older who have received at least…More
This analysis examines COVID-19 vaccination rates among older adults in states that report these data at the person-level. It also looks at the change in vaccination rates between February 4 and February 23 among a subset of these states.
The COVID-19 pandemic has underscored the stark racial and ethnic health inequities in the U.S., including among Medicare beneficiaries. Among this group, people of color, including older adults and others on Medicare, account for disproportionate shares of COVID-19 cases, hospitalizations and deaths, according to data presented in a new KFF report about racial and ethnic…More
Differences in median per capita income among White, Black, and Hispanic adults ages 65 and older are narrower when comparing people with similar levels of education, although among college graduates, the gap in income continues to be wide between Hispanic and White seniors. The gaps in savings and home equity remain wide, and are particularly …
Does Education Narrow the Gap in Wealth Among Older Adults, by Race and Ethnicity? Read More »
This analysis looks at vaccination rates among older adults at the state level, and the share of all vaccines administered that have been given to older adults, among states reporting vaccination data by age.
The payer-agnostic subsidiary, Partners in Primary Care, operates primary care centers for thousands of senior U.S. citizens. It has an aggressive growth strategy, with plans to open up to 20 new centers this year. The company is also on track to have 100 centers open by 2023.
The agency has finalized a rule that allows it to provide immediate Medicare coverage for FDA-approved products that are deemed “breakthrough devices.” The new coverage process would enable seniors to get access to these devices more quickly, but some provider and payer groups are concerned that this could cause patient harm.
Medicare Advantage enrollment has grown rapidly over the past decade, and Medicare Advantage plans have taken on a larger role in the Medicare program. More than 24 million Medicare beneficiaries (36%) are enrolled in Medicare Advantage plans in 2020. This data analysis provides updated information about Medicare Advantage enrollment trends, premiums, and out-of-pocket limits. It …
As the U.S. prepares for nationwide distribution of vaccines to combat COVID-19, some are asking whether people who get the first of two doses will return to complete the series in order to be fully immunized. This analysis draws on Medicare Part D prescription drug claims data for the herpes zoster vaccine Shingrix, which also …
Who Didn’t Get a Second Shingrix Shot? Implications for Multidose COVID-19 Vaccines Read More »
These FAQs provide the latest guidance on testing and treatment related to COVID-19 for Medicare beneficiaries.
For 2021, the average Medicare beneficiary has access to 33 Medicare Advantage plans, the largest number of options available in the last decade, and can choose from plans offered by eight firms. Among the majority of Medicare Advantage plans that cover prescription drugs, 54 percent will charge no premium in addition to the monthly Medicare …
This analysis estimates the share of older adults who reported anxiety or depression amid the COVID-19 pandemic.
People 65 and older, who have been hardest hit by COVID-19 in terms of hospitalizations and deaths, are also at high risk of severe flu illness and are more likely to die of the flu than younger people. This analysis explores variation in the rate of flu vaccination among adults ages 65 and older covered …
As the COVID-19 pandemic continues, states have taken a number of Medicaid policy actions to address the impact on seniors and people with disabilities, many of whom rely on long-term services and supports (LTSS) to meet daily needs and are at increased risk of adverse health outcomes if infected with coronavirus.
A new KFF analysis finds that 80 percent of people who have died of COVID-19 in the U.S. to date were age 65 or older, though the share varies considerably by state — from a high of 94 percent in Idaho to a low of 70 percent in the District of Columbia. The analysis of…More
This analysis examines the extent of state-level variation in the share of COVID-19 deaths accounted for by older adults, using data from the CDC as of July 22, 2020, for the week ending July 11, 2020.