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How Medicare Could Provide Dental, Vision, and Hearing Care for Beneficiaries

January 1, 2018

The Medicare program specifically excludes coverage of dental, vision, and hearing services. As a result, many beneficiaries do not receive necessary care. Those that do are subject to high out-of-pocket costs. This report examines gaps in access to dental, vision, and hearing services for Medicare beneficiaries and design a voluntary dental, vision, and hearing benefit plan with cost estimates.

Medicare Beneficiaries' High Out-of-Pocket Costs: Cost Burdens by Income and Health Status

May 12, 2017

Issue: Fifty-six million people—17 percent of the U.S. population—rely on Medicare. Yet, its benefits exclude dental, vision, hearing, and long-term services, and it contains no ceiling on out-of-pocket costs for covered services, exposing beneficiaries to high costs.Goal: To inform discussion of possible changes to Medicare, this issue brief looks at beneficiaries' out-of-pocket costs by income and health status.Methods: Spending estimates based on the Medicare Current Beneficiary Survey.Findings and Conclusion: More than one-fourth of all Medicare beneficiaries—15 million people—spend 20 percent or more of their incomes on premiums plus medical care, including cost-sharing and uncovered services. Beneficiaries with incomes below 200 percent of the poverty level (just under $24,000 for a single person) and those with multiple chronic conditions or functional limitations are at significant financial risk. Overall, beneficiaries spent an average of $3,024 per year on out-of-pocket costs. Financial burdens and access gaps highlight the need to approach reform with caution. Already-high burdens suggest restructuring cost-sharing to ensure affordability and to provide relief for low-income beneficiaries.

Medicare Payment Reform: Aligning Incentives for Better Care

June 29, 2015

The Affordable Care Act (ACA) has provided the Medicare program with an array of tools to improve the quality of care that beneficiaries receive and to increase the efficiency with which that care is provided. Notably, the ACA has created the Center for Medicare and Medicaid Innovation, which is developing and testing promising new models to improve the quality of care provided to Medicare beneficiaries while reducing spending. These new models are part of an effort by the U.S. Department of Health and Human Services to increase the proportion of traditional Medicare payments tied to quality or value to 85 percent by 2016 and 90 percent by 2018. This issue brief, one in a series on Medicare's past, present, and future, explores the evolution of Medicare payment policy, the potential of value-based payment to improve care for beneficiaries and achieve savings, and strategies for accelerating its adoption.

The Affordable Care Act and Medicare

June 9, 2015

This second report in the series Medicare at 50 Years describes how the Affordable Care Act is strengthening the program for current and future beneficiaries and outlines the major challenges that policymakers have yet to confront. By starting to move Medicare away from fee-for-service payment and holding health care providers more accountable for both the quality and total cost of care, certain ACA reforms—most notably the new Center for Medicare and Medicaid Innovation—have the potential to reshape not just the Medicare program but the entire U.S. health care system, the authors say. But the rapid influx of new beneficiaries as the postwar generation retires will necessitate further changes to Medicare, as total program outlays will likely outpace growth in the economy. Another challenge is Medicare's complex and fragmented benefit package, which as currently configured is inadequate for meeting the financial and health care needs of future beneficiaries.

Health Care Opinion Leaders' Views on Health Spending and Reform Implementation

November 14, 2011

Presents survey responses from healthcare experts about support for the reform law's coverage expansion provisions, payment and delivery system reforms, the budget reduction framework that relies in part on Medicare and Medicaid savings, and other issues.

Health Care Opinion Leaders' Views on Health Reform and the Role of States

May 23, 2011

Presents findings of a survey of experts about the relative authority of states and the federal government over the individual mandate, health insurance exchanges, provider payment methods, and other reform provisions and barriers to implementation.

High Performance Accountable Care: Building on Success and Learning From Experience

April 14, 2011

Presents the rationale for creating accountable care organizations, promising models, and the Commonwealth Fund Commission on a High Performance Health System's recommendations for implementing ACOs widely to achieve improved quality and efficiency.

Health Care Opinion Leaders' Views on Congressional Priorities

February 22, 2011

Presents survey results on healthcare experts' support for implementing the 2010 health reform, including the individual mandate, health insurance exchanges, and Medicaid expansion; incentivizing care coordination; and expanding cost-containment pilots.

Health Care Opinion Leaders' Views on Transparency and Pricing

October 25, 2010

Presents survey results on healthcare experts' views on the importance of public access to clinical quality and price information, its role in improving health system performance, and various payment reforms and mechanisms to foster efficiency and value.

Realizing Health Reform's Potential: Small Businesses and the Affordable Care Act of 2010

September 2, 2010

Examines current coverage of workers in small firms, insurers' administrative costs, and healthcare reform provisions such as small-business tax credits to offset premiums and exemption from shared responsibility payments and the estimated impact of each.

Health Care Opinion Leaders' Views on Delivery System Innovation and Improvement

July 26, 2010

Presents survey results on healthcare experts' views on strategies and models for fostering coordination and integration, such as accountable care systems, medical homes, and bundled payments; priorities among reform provisions; and market concerns.

Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update

June 23, 2010

Updates physician and patient survey data on how the U.S. healthcare system ranks against those of Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom on measures of quality, access, efficiency, equity, and healthy lives.