For many years, KFF has been tracking public opinion on the idea of a national health plan, including questions specifically about “Medicare-for-all” since 2017. This 2026 midterm election cycle, some progressive Democratic candidates have been campaigning on their support for Medicare-for-all, in which all Americans would get their insurance from a single government plan. As U.S. adults struggle to afford their health costs, many are looking for changes to the health care system. This data note summarizes current and historical KFF polling on Medicare-for-all and other national health proposals.

Views on Medicare-for-all are related to the broader question of the role of the federal government in providing access to health insurance, which has wide support among the public. Eight in ten (79%) adults say they favor the federal government doing more to help provide health insurance for more Americans, while one in five oppose a larger role for the federal government. Support for a larger federal role is bipartisan, including nearly all Democrats (94%) and eight in ten independents (82%). A smaller majority of Republicans (61%) favor a larger role for government.

This sentiment is not new. In fact, since KFF began polling on this question in 2006, three-quarters of U.S. adults or more have favored the federal government doing more to help provide health insurance to more Americans.

Medicare-for-all has reentered Democratic debates in the 2026 midterm elections, with several progressive candidates making it a central part of their campaigns. A September 2026 KFF Health Tracking Poll finds that two-thirds (66%) of the public say they favor having a national health plan, sometimes called Medicare-for-all, in which all Americans would get their insurance from a single government plan. This includes about eight in ten Democrats (84%) and seven in ten independents (72%). Most Republicans, however, oppose the proposal (66%), including about half (48%) who “strongly oppose” it.

From 2017 to 2020, views of Medicare-for-all were relatively stable, with at least half of adults consistently favoring the proposal and between four in ten and just under half opposing it. Opposition rose slightly in 2019, coinciding with debate over Medicare-for-all during the Democratic presidential primary, and when KFF asked the question in October 2020, about half (53%) were in favor and about four in ten (42%) opposed.

The latest KFF poll from September 2026 marks a new high, with two-thirds (66%) of the public favoring the proposal, while the share opposed has fallen to about a third (34%).

Support for Medicare-for-all increased across partisans between 2020 and 2026. Most notably, about seven in ten independents (72%) now favor the proposal, up from fewer than six in ten (57%) six years ago. While most Republicans oppose the plan, one-third (34%) now favor it, up from one in five (21%) in 2020. About eight in ten Democrats (84%) now favor Medicare-for-all, similar to the share who said so in 2020 (78%).

KFF polling has consistently found that public opinion on Medicare-for-all can shift substantially when people hear about potential effects of such a plan that are likely to be raised in a national debate. The share who favors such a plan rises to as much as three-quarters when people hear it would guarantee health insurance as a right for all Americans or eliminate all health insurance premiums and reduce out-of-pocket health care costs. On the other hand, favorability falls to as low as one in four when people hear it could lead to delays in getting medical tests or treatment, to about one-third when they hear it could raise taxes, and to about four in ten when they hear it could threaten the current Medicare program.

The public has mixed expectations about how a Medicare-for-all plan would affect them personally, but these expectations generally lean more negative than positive. About one-third (35%) say their ability to afford the health care they need would get better if the U.S. adopted Medicare-for-all, while 28% say it would get worse and 37% say it would stay about the same. On other aspects of their care, more U.S. adults expect things to get worse or stay about the same. The largest share, about six in ten (61%) adults, expect the amount they pay in taxes to be “worse” under a Medicare-for-all plan, while one in ten say this would be “better” and three in ten (29%) say it would be “about the same.”

Notably, adults who favor Medicare-for-all appear to support such a plan despite having mixed views on how it would impact them personally. While about half (48%) of Medicare-for-all supporters say their ability to afford the health care they need would get better under such a plan, the same share (48%) expects the amount they pay in taxes to get worse. At the same time, at least half of those who support Medicare-for-all say their own access to providers, wait times, and insurance paperwork would remain about the same. Medicare-for-all opponents are more unified, with majorities saying each of these things would get worse under such a system.

Most U.S. adults with private health insurance think they would be able to keep their current coverage under a Medicare-for-all plan. About six in ten (57%) adults with private health insurance, either through an employer or purchased themselves, say it is likely they would be able to keep their current health insurance if the U.S. adopted Medicare-for-all, including seven in ten privately insured adults who favor Medicare-for-all.

This misconception is not new. In a KFF poll from 2019, as Medicare-for-all was debated in the Democratic presidential primary, most adults with private health insurance incorrectly said they would likely be able to keep their own insurance under a national plan. Notably, most Medicare-for-all proposals, including legislation introduced by Sen. Bernie Sanders in 2017, would replace most current private health insurance with a single government plan.

A Historical Look at National Health Plan Polling

Prior to the focus on Medicare-for-all in 2017, KFF polls tracked questions about support for a single-payer health plan back to 1998. These polls showed that fewer than half of adults supported a national health plan until 2016, when it became a focus of the Democratic presidential primary with Sen. Bernie Sanders’ campaign. In KFF polls conducted from 1998 to 2004, about four in ten adults favored a national health plan while a majority opposed it. During the 2008-2009 health reform debate, an average of seven KFF polls shows just under half of adults supported the plan (46%) and about half opposed it (49%). By February 2016, half of adults favored a national health plan while about four in ten (43%) opposed it.

Phrasing the Question

Polling shows that the terminology used affects public opinion on a national health plan. A KFF Health Tracking Poll from April 2019 found that majorities of adults had positive reactions to the terms “universal health coverage” (63%), “Medicare-for-all” (63%), and “national health plan” (59%). Fewer had positive reactions to “single-payer health insurance system” (49%), a term for which about one in five did not offer an opinion. In addition, public opinion was split on “socialized medicine” (46% positive, 44% negative).

Additionally, question wording itself can impact the level of support measured for a national health plan. Polls from 2017 show that the term used, whether financing through taxes is mentioned, and whether respondents are offered the option to say they don’t know enough can all affect measured support. For example, a September 2017 Politico/Harvard poll found that fewer than half (45%) favored replacing the current health insurance system with a “single-payer system,” while two-thirds (66%) favored replacing it with a “taxpayer-funded national plan like Medicare.” Polls that mention financing through taxes have found support ranging from an even split in a 2017 NBC/Wall Street Journal poll (47% favor, 46% oppose) to a majority in favor in a CNN poll in 2017 (58%). And when a November 2017 Gallup poll explicitly offered the option to say they didn’t know enough, only about one in five said they favored (17%) or opposed (21%) a Medicare-for-all proposal, with six in ten (61%) saying they did not know enough to say.

This analysis examines recent jobs growth in health care and how it compares to the rest of the economy. Health care employment has grown faster than other sectors of the economy, with jobs in physician offices, hospitals, outpatient care centers, home health, and other settings increasing over the past year even as the rest of the job market plateaued. Since September 2025, the healthcare sector has added 372,000 jobs (up 2%), while the overall non-farm economy apart from the healthcare sector gained 124,000 jobs (up 0.1%).

These trends in health care employment may reflect the effects of an aging population and rising rates of chronic illness as well as the sector’s resilience due to the continuing need for health care even as other economic sectors experience downturns, relatively higher wages, and lower susceptibility to outsourcing and automation.

The brief is available on the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system

988 is the federally mandated suicide and crisis line, overseen by the Substance Abuse and Mental Health Services Administration (SAMHSA). Between March 2023 and June 2025, and at the direction of Congress, 988 offered a specific service to meet the needs of LGBTQ young people. The service was ended under the Trump Administration in July 2025, at a time when utilization was increasing. It was revived over a year later, on September 30, 2026, following bipartisan Congressional calls for its restoration. The line was created to address significant mental health disparities LGBTQ people experience. For instance, LGBTQ high school students report measures of suicidality, including contemplation, planning, attempts, and injury, at higher rates than heterosexual peers. Looking ahead, it is unclear how quickly or fully use of the service will return to pre-closure levels. The service’s closure may have reduced trust among LGBTQ youth and their willingness to reach out during a crisis. Limited promotion and continued absence of LGBTQ-specific outreach materials may also make it harder for young people to know that the relaunched service is available.

The line was shutdown at a time of increasing utilization. After an initial pilot period, contacts to the LGBTQ service (calls, chats, and texts) increased 71% between July 2023 and June 2025 (the last month the service was fully available). In total, the line received over 1.5 million contacts, about 10% of all 988 contacts over the same period. Use of the service also grew in the months leading up to its closure, increasing by 17% between December 2024 to June 2025, the period following the presidential election and President Trump’s inauguration.

While the administration said the closure of the specialty service was “to focus on serving all help seekers, including those previously served through the Press 3 option (emphasis theirs),” the decision came amid a range of other actions the administration took to limit health care access and protections for LGBTQ people, particularly transgender people. These actions included issuance of a day one Executive Order (EO 14168) on gender in January 2025, which sought to “remove recognition of the concept of gender identity” and thus federal recognition of transgender people, among other policy changes.

In May 2025, just prior to the line’s closure, and following a presidential budget proposal that proposed eliminating funding for the LGBTQ service, bipartisan members of both chambers of Congress urged HHS to preserve the service, citing its widespread use and elevated suicide risks among LGBTQ youth. After the service closed in July 2025, members of Congress continued to call for its return through multiple letters with some bipartisan engagement.

Congress had specifically funded the service since FY 2023, when it appropriated funding “to provide specialized services for LGBTQ+ youth,” which included training for existing counselors in LGBTQ+ youth cultural competency and transfer of LGBTQ+ youth contacts to a specialty organization. Funding increased to $33.1 million in FY2024 and remained at that level through FY2026. In fact, when it came to FY2026 funding, members wrote to their appropriator colleagues with requests to continue to fund the service. There has not yet been a final FY2027 funding bill passed, and the government is currently operating under a short-term continuing resolution which includes funding for 988 and the LGBTQ line at the FY2026 level.

In a June 9^th letter to Rep. Krishnamoorthi, SAMSHA, writing on behalf of Department of Sec. Kennedy, responded to Congress, writing that the agency was assessing reopening the line “while ensuring compliance with Executive Order 14168.” Nearly four months later, the specialized LGBTQ youth service was ultimately restored on September 30^th, 2026. Language on the bottom of the 988 webpages emphasizes that the service was restored in response to congressional funding and direction and that its content does not necessarily reflect administration policy or views. The statement reads:

Looking to the future, it is too soon to know how the closure affected young people’s trust in the service and their willingness to use it. It is also not clear whether LGBTQ youth, who could benefit from the service, will be able to find it. The LGBTQ specific promotional materials, first removed in February 2025, remain offline as of October 1, 2026. Promotional materials continued to be available for other populations, including Black and Latino people, people who are deaf or hard of hearing, and rural communities. In addition, as of October 1, 2026, there was no landing page for the specialized service, no prominent explanation of the restored service, and no mention of the service in the “what to expect” section that prepares people for what to expect when they call 988. Previously, the site provided information specifically about this service. Additionally, metrics on service utilization on the 988 data dashboard are now back up but could be hard find as it is referred to only as the “press 3 option,” rather than the LGBTQ line. Whether the line continues to be specifically funded by Congress may also affect the scope and visibility of the service over time.

The federal government continues to focus on addressing fraud, waste, and abuse in Medicaid, with much of the attention focused on home care services. KFF estimates that over 5 million people use Medicaid home care, which provides help with self-care activities such as bathing, dressing, and eating for older adults and people with disabilities. Home care has been an area of emphasis in new fraud initiatives because spending on home care is growing, and the services are provided in people’s homes and the community where fewer institutional processes and procedures exist. However, spending growth often reflects states’ efforts to increase the availability of home care, and there are additional safeguards against fraud in home care compared with other types of Medicaid services. While additional scrutiny and oversight may limit fraudulent or inappropriate Medicaid spending, additional efforts to combat fraud can create new administrative burdens and limit provider participation, potentially reducing access to care. Aside from waiting lists (an imperfect measure of unmet need), there are generally no metrics to examine how many people who need Medicaid home care are not receiving benefits. States are engaged in many activities aimed at addressing fraud, waste, and abuse in their Medicaid home care programs; in KFF’s 2026 survey of states’ home care programs, the majority of responding states reported that program integrity was one of the top three priorities they were concerned with.

The data come from the 24^th annual KFF survey of officials administering Medicaid home care programs in all 50 states and the District of Columbia (hereafter referred to as a state). States completed the survey between April and August 2026. The survey was sent to each state official responsible for overseeing home care benefits (including home health, personal care, and waiver services for specific populations such as people with physical disabilities). All states except Florida and South Carolina responded to the 2026 survey, but response rates for certain questions were lower.

KFF’s survey finds that all responding states report using multiple program integrity practices beyond federal minimum requirements to prevent and detect fraud, with nearly all states employing a multifaceted approach. The federal government has requirements for states to identify and detect fraud in Medicaid home care; however, all responding states report using strategies that go beyond the federal requirements. KFF asked states whether they used any of eight strategies to “help identify and reduce fraud and abuse in the provision of waiver services,” and 42 states reported using all eight of the strategies that KFF asked about.

Federal law relies on electronic visit verification (EVV) as a core tool to prevent fraud in Medicaid home care, but all responding states reported using EVV practices that go beyond federal requirements (Figure 1). In 2016, Congress passed the 21^st Century Cures Act, which requires states to implement electronic visit verification (EVV) for all Medicaid personal care and home health services if a visit is made to a person in the home. EVV is a computer/mobile system that tracks and records details of services. States’ EVV systems must include six data elements: the enrollee receiving the service, caregiver providing the service, type of service, location of the service delivery, date of the service, and time the service begins and ends. EVV was established to help promote fiscal integrity for Medicaid home care, and states had until 2023 to fully implement the requirements.

While the 21st Century Cures Act mandates that states implement EVV and collect six specific data elements for each visit, it does not specify how states must store EVV data or use it as part of their payment processes. States may choose to apply EVV data in additional ways to support program integrity.

KFF asked states about three potential EVV strategies that go beyond minimum federal requirements and found they were widely used:

• Maintaining EVV data in machine-readable files (48 states),
• Cross-checking billed claims against EVV data (48 states), and
• Analyzing EVV data to identify unusual billing patterns (47 states).

Some states reported adopting strategies that precondition payment on EVV submissions, such as Ohio, which requires valid EVV data as a condition of payment in its waivers for people with intellectual and developmental disabilities (I/DD) and for adults ages 65 and older and those with physical disabilities. Claims that do not have a matching EVV record will be denied, rather than paid and later audited to track down mismatched claims.

In addition to EVV, all responding states reported using at least one other type of program integrity strategy beyond what is federally required. KFF asked states whether they were using any of the following non-EVV related strategies:

• Analyzing claims by provider to identify unusual billing patterns (48 states),
• Analyzing claims by enrollee to identify unusual patterns of service receipt (45 states),
• Updating the care plan and service authorizations annually or more frequently (47 states),
• Requiring in-person assessments to establish service authorizations in the care plan (46 states), and
• Verifying claims are in line with care plan service authorizations prior to payment (47 states).

Seventeen states also reported using other program integrity strategies outside of the options KFF included, although most states did not describe those options in much detail. Some strategies mentioned focused on provider certification and enrollment requirements whereas others were focused on identifying claims that required additional review before or after payment.

Nearly half of states are currently using or planning to incorporate artificial intelligence (AI) into program integrity and data monitoring activities (Figure 2). KFF asked states to report their current phase of AI tool use for “program integrity and data monitoring (to identify potential fraud, waste, and abuse).” States could report one of five options: currently using, piloting, planning to use, not using, or unknown. Twelve states reported currently using AI-enabled tools for program integrity and data monitoring purposes under at least one program (Arizona, Arkansas, Connecticut, Indiana, Michigan, Missouri, Montana, Nevada, New Mexico, North Carolina, Texas, and Washington). For example, North Carolina reported using AI to create algorithms that would detect fraud, waste, and abuse in its waiver for adults ages 65 and older or with physical disabilities, and Missouri reported using AI to aggregate information about critical incidents and grievances. Of the 12 states currently using AI tools, five states (Arkansas, Connecticut, Michigan, Montana, and North Carolina) also reported they are planning to incorporate AI tools under at least one additional program. One state (California) reported piloting AI-enabled tools for program integrity purposes. Eight states (Alaska, Delaware, Georgia, Hawaii, Mississippi, New Hampshire, New York, and Wyoming) reported that they are not currently using AI tools for program integrity, but that they are planning to incorporate them in the future.

The adoption of AI-enabled tools is most commonly reported under waivers for people with I/DD and adults ages 65 and older and those with physical disabilities. Over one in four states with waivers for people with I/DD and waivers for adults ages 65 and older and those with physical disabilities are currently using or are planning to incorporate AI-enabled tools for their program integrity and data monitoring activities. Seven states with waivers for adults ages 65 and older or those with physical disabilities and five states with waivers for people with I/DD are currently using AI tools for their program integrity and data monitoring activities, more than any other waiver type.

Appendix

Medicaid is the primary payer for long-term care (LTC) in the U.S. and pays for more than two-thirds of the LTC delivered in home- and community-based settings. Most home care (also known as “home- and community-based services” or HCBS) is optional for states to provide and is frequently offered through “waivers,” which allow states to cover a wide range of benefits and to choose—and limit—the number of people who receive services. KFF estimates that more than 5 million Medicaid enrollees use home care, and that about half of people are using home care through waivers. States’ ability to cap the number of people enrolled in home care waivers can result in waiting lists when the number of people seeking services exceeds the number of waiver slots available.

Passed last year, the 2025 reconciliation law made substantial changes to Medicaid that are expected to significantly reduce federal funding for Medicaid and lead to coverage loss for many current enrollees, placing new financial pressures on states, providers, and enrollees. Given the substantial share of Medicaid spending that pays for home care, and the optional nature of most home care programs, cuts to home care programs could occur as states respond to reduced federal spending. If states cut home care by reducing the number of people who can receive waiver services, waiting lists could increase. Proposals to cut home care may face challenges because people who rely on such services have complex health care needs and because elections may make it more difficult to restrict coverage. Recent tracking of programmatic changes to Medicaid home care highlights that some states have cut their programs, but in many cases, proposed cuts were not enacted, and other states continue to make enhancements.

Waiting lists could also increase because of changes to immigration policy in states that use waiting lists to manage shortages of home care workers. Three in 10 direct care workers are immigrants, and recent federal policy changes could further exacerbate the challenge of retaining and growing the workforce.

This data note provides new information about waiting lists in Medicaid home care before many of the provisions in the reconciliation law go into effect. Waiting lists are an incomplete measure of unmet need (Box 1) and are not necessarily comparable across states or over time. The data come from the 24^th KFF survey of officials administering Medicaid home care programs in all 50 states and the District of Columbia (hereafter referred to as a state), which states completed between April and August 2026. The survey was sent to each state official responsible for overseeing home care benefits (including home health, personal care, and waiver services for specific populations such as people with physical disabilities). All states except Florida and South Carolina responded to the 2026 survey. To facilitate comparisons over time, Florida’s responses to the 2022 survey and South Carolina’s responses to the 2025 survey were included with their permission. Survey findings are reported by state and waiver target population, although states often offer multiple waivers for a given target population. Key takeaways include:

• Forty states maintain waiting lists or interest lists for people who would like to receive home care, a number that fluctuated little between 2016 and 2026.
• In all years since 2016, there have been at least 0.5 million people on waiting lists or interest lists, with a total of almost 650,000 in 2026.
• In 2026, two states reported having at least one new waiting list (across three waivers), and 32 states reported an increase in the number of people on waiting lists or interest lists compared with only 7 states reporting a decrease.

• Most people on waiting lists or interest lists have intellectual or developmental disabilities (I/DD), and most live in states that do not screen any people for eligibility prior to adding them to waiting lists.
• Most people on waiting lists or interest lists are eligible for personal care provided through states’ regular Medicaid programs or for services provided through specialized state plan home care benefits.

KFF also recently updated the waiting list indicators on State Health Facts, which show data by state and target population.

How Many States Have Waiting Lists for Home Care?

Between 2016 and 2026, the number of states with waiting lists has fluctuated between 37 and 41 and is currently at 40 states (Figure 1). While some Affordable Care Act (ACA) opponents have cited waiver waiting lists to argue that expanding Medicaid diverts funds from adults ages 65+ and those with physical disabilities, research shows that ACA Medicaid expansion has led to gains in coverage for people with disabilities and chronic illnesses. Waiting lists for home care predate the ACA Medicaid expansion, which became effective in most states in 2014, and both expansion and non-expansion states have waiting lists. Waiver enrollment caps have existed since home care waiver authority was added to federal Medicaid law in the early 1980s.

While the overall number of states with waiting lists did not change much from 2025 to 2026, there were more changes in waiting lists for specific states and for specific types of waivers. Seven states (across eight waivers) removed waiting lists, including Nebraska, which no longer reported any waiting lists, and Oregon, which eliminated a waiting list of 1,000 people from its Section 1115 waiver for adults ages 65+ and those with physical disabilities. Two states (across three waivers) reported new waiting lists. Washington reported new waiting lists for people with I/DD (275 people) and adults ages 65+ and those with physical disabilities (waiting list size unknown), and Kentucky reported a new waiting list for individuals with traumatic brain or spinal cord injuries (5 people).

How Many People Are on Waiting Lists for Home Care?

Between 2025 and 2026, total enrollment in waiting lists and interest lists increased by about 7% and is almost 650,000 in 2026 (Figure 2). Overall, there was an increase in the number of people on waiting or interest lists in 32 states and a decrease in 7 states. One factor that contributes to changes over time is changes in states’ policies for managing their waiting lists. In 2026, several states changed their policies, but those changes did not result in any major increases or decreases in waiting lists. However, that has not been true in past years. For example, between 2018 and 2020, the total number of people on waiting lists decreased by 155,000, or 19%. Nearly half of that change came from Ohio’s implementation of a waiting list assessment of waiver eligibility, which reduced the size of the state’s waiting list by nearly 70,000 people. In 2026, most states (32) with waiting lists screen individuals for waiver eligibility for at least one waiver, but even among those states, four (California, Maryland, Mississippi, and Washington) do not screen for all waivers. The eight states that do not screen for eligibility among any waivers (Alaska, Florida, Iowa, New Mexico, Oklahoma, Oregon, South Carolina, and Texas) account for over half (56%) of all people on waiting lists.

In 2026 and earlier years, a disproportionate number of people on home care waiting lists or interest lists lived in states that did not screen people on waiting lists for eligibility. One reason waiting lists provide an incomplete picture of need is that not all people on waiting lists will be eligible for services. The number of states that do not screen for eligibility on any waiting lists ranged from six to eight states between 2022 and 2026, yet the share of individuals on waiting lists in these states ranged from 40% to 56%. Interviews about home care waiting lists found that when waiver services are provided on a first-come, first-served basis, people enroll in waiting lists in anticipation of future need. That study found that in some states, families would add their children to waiting lists for people with I/DD at a young age, assuming that by the time they reached the top of the waiting list, their children would have developed the immediate need for services. Many of those waivers offer comprehensive home care packages that include supported employment, supportive housing, or round-the-clock services. Among the eight states that do not screen people for eligibility on any lists, seven have only waiting lists and one has only interest lists.

Who Is on Waiting Lists for Home Care?

Most people on waiting lists have I/DD, particularly in states that do not screen for waiver eligibility before placing someone on a waiting list. People on waiting lists for waivers serving people with I/DD (which include waivers specific to people who have autism) make up 78% of waiting lists in states that do not screen for waiver eligibility, compared with 61% in states that do determine waiver eligibility before placing someone on a waiting list. People with I/DD make up almost three-quarters (72%) of the total waiver waiting list population (Figure 3). Adults ages 65+ and those with physical disabilities account for one-quarter (25%), while the remaining share (3%) includes children who are medically fragile or technology dependent, people with traumatic brain or spinal cord injuries, people with mental illness, and people with HIV/AIDS. People who are on home care waiting lists are generally not representative of the Medicaid population or the population that uses home care. Most people on waiting lists have I/DD, but KFF analysis shows that people with I/DD make up fewer than half of the people served through 1915(c) waivers (the largest source of Medicaid home care spending).

How Long Are People on Waiting Lists for Home Care?

In 2026, people on waiting or interest lists accessed services after an average of 34 months (35 of 40 states responding), up from 32 months in 2025. People with I/DD wait 38 months on average. The average waiting period for other waiver populations ranged from 8 months for waivers targeting medically fragile and technology-dependent children to 65 months for waivers that serve people with autism.

Most people on waiting or interest lists for whom living arrangements are known live in community settings while they wait. Among the 649,900 people on lists for waiver services in 2026, living arrangements are unknown for more than 425,000. Among the people whose living arrangements are known, 95% (213,800) live in the community and 5% (10,900) live in institutional settings. Although most people on waiting lists live in the community, that may not be true for all waivers. In one California waiver for adults ages 65+ and those with physical disabilities, nearly half of the 16,100 people on the waiting list are living in institutions.

While waiting for waiver services, people living in the community are likely to be eligible for other home care through Medicaid state plans. Of the more than 5 million people who use home care, KFF estimates that roughly half use services provided through the Medicaid state plan, such as personal care to help with bathing or preparing meals, therapies to help people regain or acquire independent living skills, and assistive technology. States may not use waiting lists to restrict the number of people eligible to use such services, and over 80% of people on home care waiting lists are eligible for personal care or other state plan services. They would not, however, have access to more specialized services such as supported employment or adult day care. People on waiting lists who receive state plan services may also have fewer hours of personal care than they would in a waiver program, or they may not have assistance with some of the activities they need help with, such as bathing, dressing, preparing meals, or managing medication.

The Centers for Medicare & Medicaid Services (CMS) has just released information about Medicare Part D plans for 2027, including plan availability and premiums for the coming year. The agency emphasized stability in the Part D prescription drug plan (PDP) marketplace for 2027 (as it did for 2026) and estimated only a modest $1 increase in the average monthly PDP premium from $35 to $36. KFF analysis of PDP availability and premiums for 2027 shows a mixed picture, with modest premium increases for many Part D enrollees for their current plan but steeper increases for others, and a reduction in the number of PDP options for the fourth year in a row. Key takeaways include:

• The number of stand-alone PDPs available to the average beneficiary will fall for the fourth year in a row, from 11 in 2026 to 9 in 2027. PDP availability in 2027 varies by state, ranging from 8 PDPs in 15 states to 12 PDPs in 1 state, the same range as in 2026 but with most states having 8 or 9 PDPs rather than 10 or more.
• Many PDP enrollees will see premium reductions or only modestly higher premiums in 2027 if they keep their current plan, but others will face substantially higher premiums. Enrollees in six of the eight PDPs that will continue to be offered on a national basis in 2027 will see premium reductions in some states if they keep their current plan, but enrollees in many other states will see higher premiums for these same plans if they don’t switch. Centene continues to offer the lowest-premium PDPs in 2027, with premiums for both Wellcare PDPs under $10 per month in many states, while enrollees in United’s AARP-branded PDPs will face substantially higher premiums and monthly increases of $50 or more in many states if they keep their current plan.
• There will be no zero premium PDPs available for Part D enrollees who do not receive low-income subsidies (LIS) in 2027. All 4 million PDP enrollees who paid no monthly premium in 2026 will face higher premiums in 2027 whether they keep their current plan or switch to a new PDP.
• With 56% of all Part D enrollees in Medicare Advantage drug plans in 2026, a majority of Part D enrollees will not be affected by PDP premium changes and may not face premium increases of any magnitude. Medicare Advantage plans can use rebate dollars from the federal government to reduce premiums for prescription drug coverage, funds that are not available to plan sponsors for PDPs.
• Ending the Part D Premium Stabilization Demonstration did not result in substantially higher across-the-board PDP premiums but still likely affected premium levels for 2027. The disappearance of zero premium PDPs for Part D enrollees without low-income subsidies and monthly premium increases greater than $50 for some PDP enrollees if they keep their current plan are possibly related to the termination of extra subsidies that were provided to PDP plan sponsors under the demonstration.

Findings

The number of stand-alone PDPs available to the average beneficiary will fall for the fourth year in a row, from 11 in 2026 to 9 in 2027, while the total number of stand-alone drug plans available will fall from 360 plans nationwide offered by 17 parent organization in 2026 to 316 plans offered by 15 parent organizations in 2027. The reduction in PDP offerings is largely due to two plan sponsors scaling back: Health Care Service Corporation is withdrawing the HealthSpring Extra Rx PDP from 22 regions, and CVS Health is withdrawing the Silverscript Choice PDP from 13 regions. Humana remains the only insurer offering three PDPs in all 34 PDP regions. PDP availability in 2027 varies by state, ranging from 8 PDPs in 15 states to 12 PDPs in 1 state (Figure 1) – the same range as in 2026 but with most states having 8 or 9 PDPs rather than 10 or more. Medicare Part D enrollees in almost all states will see a modest reduction in the number of PDPs for 2027, except Florida which is gaining 1 PDP and no change in 4 other states (Table 1).

Many PDP enrollees will see premium reductions or only modestly higher premiums in 2027 if they keep their current plan, but others will pay substantially higher premiums. Enrollees in six of the eight PDPs that will continue to be offered on a national basis in 2027 will see premium reductions in some states if they keep their current plan, but enrollees in many other states will see higher premiums for these same plans if they don’t switch (Figure 2).

Other takeaways from an initial analysis of 2027 PDP premiums and changes from 2026 include:

• There will be no $0 premium PDPs available for Part D enrollees who do not receive low-income subsidies (LIS) in 2027. According to KFF analysis, 28% of PDP enrollees without LIS, or 4 million PDP enrollees, paid no monthly premium in 2026. All these enrollees will face higher premiums in 2027 whether they keep their current plan or switch to a new PDP. This includes:
  • Humana Basic Rx PDP enrollees in 28 states, facing premium increases of $6.30 to $30.60 per month if they keep this plan;
  • Wellcare Value Script and Wellcare Classic enrollees in 16 states, facing monthly increases of $5.30 and $7.30 respectively;
  • HealthSpring Assurance Rx enrollees in 11 states, facing monthly increases of $9.30 to $14.70;
  • Humana Value Rx enrollees in 5 states, facing monthly increases of $17.20 to $22.30; and
  • AARP Medicare Rx Saver enrollees in 3 states, facing a monthly increase of $10.30.
• Centene continues to offer the lowest premium PDPs, with 2027 monthly premiums of $5.30 for Wellcare Value Script in 45 states and $7.30 for Wellcare Classic in 33 states. For the 5.9 million non-LIS enrollees in Wellcare Value Script in 2026, those in 29 states will see premium reductions in 2027 ranging from less than $1 to $17.50 if they keep their current plan, while those in another 22 states will see premium increases in 2027 ranging from less than $1 to $5.30.
• Enrollees in United’s AARP-branded PDPs will face substantially higher premiums in many states if they keep their current plan, with monthly premium increases of $50 or more in all 50 states and DC for AARP Medicare Rx Preferred (including 37 states with premium increases greater than $75 and 4 states with premium increases of more than $100) and increases of $50 or more in 33 states for AARP Medicare Rx Saver. Together, these plans enroll more than 2 million non-LIS enrollees in 2026. Switching to a less expensive PDP is an option in all areas, but KFF analysis shows that many enrollees don’t compare plans or switch during open enrollment.

With 56% of all Part D enrollees in Medicare Advantage drug plans in 2026, a majority of Part D enrollees will not be affected by PDP premium changes and may not face premium increases of any magnitude. According to CMS, the average Medicare Advantage drug plan premium for 2027 will continue to be considerably lower than the average monthly PDP premium, and it’s likely that most MA-PD enrollees will be in plans charging zero premium in 2027, as in 2026 and previous years. This is because Medicare Advantage plans can use rebate dollars from the federal government to reduce premiums for prescription drug coverage, funds that are not available to plan sponsors for PDPs.

Ending the Part D Premium Stabilization Demonstration did not result in substantially higher across-the-board PDP premiums but still likely affected premium levels for 2027. CMS’s decision to terminate the Part D Premium Stabilization Demonstration for 2027, rather than continue it for a third year as originally planned when the demonstration was announced, seemed to point in the direction of higher premiums for PDP coverage in 2027. The demonstration provided extra subsidies to PDP plan sponsors, and by extension PDP enrollees, in two ways – reducing the base beneficiary premium, which is used in the calculation of individual plan premiums, and capping the year-over-year increase in the monthly premium. CMS determined that the extra financial support provided to PDP sponsors under the demonstration was no longer needed after 2026, and in fact, across-the-board substantial PDP premium increases for 2027 didn’t materialize. However, the disappearance of zero premium PDPs for Part D enrollees without low-income subsidies is a possible outcome of the termination of the demonstration, and eliminating the cap on the year-over-year increase in the monthly PDP premium has meant that monthly premium increases greater than $50 are possible for some PDP enrollees if they keep their current plan.

Even if the monthly premium for a given Part D drug plan is decreasing or increasing only modestly, premiums are only one feature for beneficiaries to consider when evaluating their Part D coverage. As is commonly advised during open enrollment, Medicare beneficiaries may want to evaluate what other features of their Part D plan might be changing, including what drugs are and aren’t covered on the plan’s formulary, tier placement of covered drugs, deductibles, and cost-sharing requirements. With Part D costs overall on the rise, the tradeoff Part D enrollees might face as their premium increases are kept in check is that their coverage may be getting less generous, which could mean fewer drugs covered, higher cost-sharing requirements, or greater utilization management restrictions – or possibly a combination of all three.