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While Medicare covers a wide range of health care services, Medicare beneficiaries generally pay out-of-pocket for their monthly premiums, deductibles, and cost sharing for Medicare covered services. This brief provides an overview of the costs faced by Medicare beneficiaries in traditional Medicare, Medicare Advantage, and Medicare Part D, including premiums, deductibles, copays, and coinsurance, focusing on costs in 2026.
The analysis shows that plan level Medicare Advantage prescription drug availability varies widely across the country in 2027, with a modest reduction in the share of enrollees having more than 40 MA-PDs to choose from compared to 2026, and some major insurers exiting a much larger number of counties than they are entering.
Each year, Medicare beneficiaries have an opportunity to make changes to how they receive their Medicare coverage during the nearly 8-week annual open enrollment period. This brief answers key questions about the Medicare open enrollment period and Medicare coverage options.
This brief analyzes the Medicare Part D stand-alone prescription drug plan (PDP) market for 2027. The analysis shows that there will be a modest reduction in the number of PDPs for 2027, along with modest premium increases less than $10 per month for many enrollees, but much larger monthly premium increases of $50 or more for others if they don’t change plans.
This Health Policy 101 chapter explores Medicare, a federal health insurance program covering more than 68 million people, established in 1965 for people age 65 or older and later expanded to cover people under age 65 with long-term disabilities. In addition to detailing Medicare eligibility, coverage, and spending, the chapter examines the increased role of private plans in providing benefits and the financing challenges posed by increasing health care costs and an aging population.
The average Medicare beneficiary will have 28 Medicare Advantage prescription drug (MA_PD) plans available for general enrollment in 2027. The number of plans varies widely across states.
This analysis of available 2025 prior authorization data finds insurers denied at least 1 in 8 standard requests for prior authorization across three insurance markets: Medicare Advantage, Medicaid managed care, and the federally facilitated ACA Marketplaces. Denial rates varied wide segments by insurer. The analysis highlights limitations of the data and challenges for consumers interpreting it.
The Medicare program will spend at least $13 billion on the Medicare Advantage quality bonus program in 2026, as 68% of Medicare Advantage enrollees are in a plan that qualifies for higher payments under the program.
As an increasing share of older adults have adopted digital health technologies over the past several years, and with most expressing interest in using them to manage their health care, the Centers for Medicare & Medicaid Services (CMS) has introduced several initiatives to expand the use of digital health technologies in Medicare. This brief summarizes these initiatives and draws on data from various surveys, including KFF Tracking Polls from September 2025 and March 2026, to…
Two recent reports find that Medicare Advantage organizations deny prior authorization requests for long-term care hospital, inpatient rehabilitation hospital, and skilled nursing facility stays at higher rates than requests overall. When these decisions are appealed, they are frequently overturned, particularly for skilled nursing facility stays. This may cause delays for Medicare beneficiaries who are particularly vulnerable or have high care needs.
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