Seniors

August 11 Web Event: Understanding the Health Care Provisions in the Inflation Reduction Act

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

Medicaid Public Health Emergency Unwinding Policies Affecting Seniors & People with Disabilities: Findings from a 50-State Survey

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.

Medicare Part B Drugs: Cost Implications for Beneficiaries in Traditional Medicare and Medicare Advantage

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 …

Medicare Part B Drugs: Cost Implications for Beneficiaries in Traditional Medicare and Medicare Advantage Read More »

Combined Federal and State Spending on Medicaid Home and Community-Based Services (HCBS) Totaled $116 billion in FY 2020, Serving Millions of Elderly Adults and People with Disabilities

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

Medicaid Home & Community-Based Services: People Served and Spending During COVID-19

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 »

State Policy Choices About Medicaid Home and Community-Based Services Amid the Pandemic

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 »

Feb. 23 Web Event: The Gift of Experience vs. the Stress of Isolation: Older People Share How They’ve Made It Through the Pandemic

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

Feb. 23 Web Event: The Gift of Experience vs. the Stress of Isolation: Older People Share How They’ve Made It Through the Pandemic

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

Simulating the Impact of the Drug Price Negotiation Proposal in the Build Back Better Act

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 …

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Why Medicare’s Aduhelm Coverage Decision Could Increase Pressure on Officials to Roll Back the Record Part B Premium Increase for 2022

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

Summary of Costs and Impact of the Prescription Drug Provisions in the Build Back Better Act

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

Explaining the Prescription Drug Provisions in the Build Back Better Act

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 in 2022, Up 8 Percent From 2021, While the Number of Medicare Part D Stand-Alone Plans is Decreasing Mainly Due to Firm Consolidations

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

Medicare Advantage 2022 Spotlight: First Look

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 …

Medicare Advantage 2022 Spotlight: First Look Read More »

Medicare Part D: A First Look at Medicare Prescription Drug Plans in 2022

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 »

Bill aiming to streamline MA prior authorization gains House majority support

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.

Oct. 21 Web Event: Confronting Ageism in Health Care: A Conversation for Patients, Caregivers and Clinicians

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

Large Majorities Across Parties Favor Allowing the Federal Government to Negotiate Drug Prices, Even After Hearing Common Arguments About It

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

Devoted Health raises $1.1B, sending valuation soaring past $12B

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.

The Decline in COVID-19 Deaths Among Nursing Home Residents and Staff Reversed Course Amid the Surging Delta Variant This Summer

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

Many Medicare Beneficiaries Face High Out-of-Pocket Costs for Dental and Hearing Care, Whether in Traditional Medicare or Medicare Advantage

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

Dental, Hearing, and Vision Costs and Coverage Among Medicare Beneficiaries in Traditional Medicare and Medicare Advantage

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 …

Dental, Hearing, and Vision Costs and Coverage Among Medicare Beneficiaries in Traditional Medicare and Medicare Advantage Read More »

Potential Savings for Medicare Part D Enrollees Under Proposals to Add a Hard Cap on Out-of-Pocket Spending

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 …

Potential Savings for Medicare Part D Enrollees Under Proposals to Add a Hard Cap on Out-of-Pocket Spending Read More »

CareMax to add 50 new senior care centers through Anthem collaboration

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.

How Would Drug Price Negotiation Affect Medicare Part D Premiums?

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 »

Direct Care Workforce Shortages Have Worsened in Many States During the Pandemic, Hampering Providers of Home and Community-Based Services

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

State Medicaid Home & Community-Based Services (HCBS) Programs Respond to COVID-19: Early Findings from a 50-State Survey

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 …

State Medicaid Home & Community-Based Services (HCBS) Programs Respond to COVID-19: Early Findings from a 50-State Survey Read More »

Lacking Dental Coverage, Many People on Medicare Forgo Dental Care, Especially Beneficiaries of Color

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 and Dental Coverage: A Closer Look

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 …

Medicare and Dental Coverage: A Closer Look Read More »

Millions of Medicare Part D Enrollees Have Had Out-of-Pocket Drug Costs High Enough to Exceed the Catastrophic Threshold Over Time

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

What’s the Latest on Medicare Drug Price Negotiations?

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 »

Millions of Medicare Part D Enrollees Have Had Out-of-Pocket Drug Spending Above the Catastrophic Threshold Over Time

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 …

Millions of Medicare Part D Enrollees Have Had Out-of-Pocket Drug Spending Above the Catastrophic Threshold Over Time Read More »

State Options to Expand Medicaid HCBS: Examples & Evaluations of Section 1115 Waivers

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 »

Study: Black, Hispanic beneficiaries driving MA enrollment growth

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.

Cano Health buys Doctor’s Medical Center for $300M

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.

Former CMMI director’s new company will focus on value-based rural healthcare

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’s $600M acquisition will add 24,000 MA members to its roster

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.

FDA’s Approval of Biogen’s New Alzheimer’s Drug Has Huge Cost Implications for Medicare and Beneficiaries

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 …

FDA’s Approval of Biogen’s New Alzheimer’s Drug Has Huge Cost Implications for Medicare and Beneficiaries Read More »

CMS ups Medicare payment for at-home vaccinations to about $75 per dose

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.

Key Facts About Medicare Part D Enrollment, Premiums, and Cost Sharing in 2021

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.

Lowering the Age of Medicare Eligibility to 60 Could Reduce the Cost of Health Care and Have a Modest Effect on the Number of People Who Are Uninsured

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

Medicare-Covered Older Adults Are Satisfied with Their Coverage, Have Similar Access to Care as Privately-Insured Adults Ages 50 to 64, And Fewer Report Cost-Related Problems

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.

Lowering the Age of Medicare Eligibility Would Likely Reduce Health Spending for Employers, But Raise Costs for the Federal Government by Covering More People in Medicare

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

Health Spending for 60-64 Year Olds Would Be Lower Under Medicare Than Under Large Employer Plans

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 …

Health Spending for 60-64 Year Olds Would Be Lower Under Medicare Than Under Large Employer Plans Read More »

COVID-19 Deaths and Cases in Long-Term Care Facilities Have Fallen to All-Time Lows in the Four Months Since Vaccinations Began

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

COVID-19 Long-Term Care Deaths and Cases Are at An All-Time Low, Though A Rise In LTC Cases In A Few States May Be Cause for Concern

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 …

COVID-19 Long-Term Care Deaths and Cases Are at An All-Time Low, Though A Rise In LTC Cases In A Few States May Be Cause for Concern Read More »

Potential Impact of Additional Federal Funds for Medicaid HCBS for Seniors and People with Disabilities

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 …

Potential Impact of Additional Federal Funds for Medicaid HCBS for Seniors and People with Disabilities Read More »

How the pandemic transformed primary care for seniors

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.

State Variation in Medicaid LTSS Policy Choices and Implications for Upcoming Policy Debates

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, …

State Variation in Medicaid LTSS Policy Choices and Implications for Upcoming Policy Debates Read More »

States Have Made Progress in Vaccinating Older Adults Against COVID-19 in Recent Weeks, But No State Has Vaccinated At Least Half of its Older Population

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

The COVID-19 Pandemic Has Hit People of Color the Hardest, Including Among People With Medicare

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

Does Education Narrow the Gap in Wealth Among Older Adults, by Race and Ethnicity?

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 »

New CMS rule to enable immediate coverage for FDA-designated ‘breakthrough’ devices

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.

A Dozen Facts About Medicare Advantage in 2020

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 …

A Dozen Facts About Medicare Advantage in 2020 Read More »

Who Didn’t Get a Second Shingrix Shot? Implications for Multidose COVID-19 Vaccines

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 »

Medicare Advantage 2021 Spotlight: First Look

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 …

Medicare Advantage 2021 Spotlight: First Look Read More »

Lower Flu Vaccination Rates Among Black, Hispanic, and Low-Income Seniors Suggest Challenges for COVID-19 Vaccination Efforts

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 …

Lower Flu Vaccination Rates Among Black, Hispanic, and Low-Income Seniors Suggest Challenges for COVID-19 Vaccination Efforts Read More »

State Actions to Sustain Medicaid Long-Term Services and Supports During COVID-19

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.