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To understand the role of Medicare Part D stand-alone prescription drug plans in serving rural Medicare beneficiaries, this data note analyzes 2025 Part D enrollment in PDPs and Medicare Advantage drug plans by geographic area nationally and at the state level.
In a new analysis, KFF finds that 3.6 million people with Medicare could be eligible for coverage of Wegovy (semaglutide) now that the Food and Drug Administration has approved the use of the anti-obesity drug to reduce the risk of heart attacks and stroke in certain patients. This change potentially allows access to Wegovy for just over 1 in 4 of the 13.7 million people on Medicare diagnosed with obesity or overweight, based on data…
Medicare Part D is a voluntary outpatient prescription drug benefit for people with Medicare provided through private plans, including stand-alone prescription drug plans and Medicare Advantage plans that offer drug coverage. This analysis provides an overview of Medicare Part D plan availability, premiums, and cost sharing in 2025 and key trends over time.
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 provide a comprehensive profile of dental, hearing, and vision benefits in Medicare.
This analysis provides the latest data about Medicare Part D enrollment, premiums, and cost sharing in 2022 and trends over time, including information about stand-alone prescription drug plans (PDPs) and Medicare Advantage prescription drug plans.
Based on interviews with senior executives at 14 large firms, the issue brief finds that insurers anticipate continuing to offer Medicare Advantage plans in 2012, in part because of a Medicare demonstration project that will award bonus payments to plans based on their quality standards. A companion issue brief examines trends in Medicare Advantage enrollment in 2011. The analysis was conducted by researchers at Mathematica Policy Research, Inc. and the Kaiser Family Foundation. Issue Brief…
This analysis examines the recent growth of Medicare Advantage as a share of hospital inpatient days. Medicare Advantage rose from 13% to 25% of all inpatient days from 2015 to 2023, although there was wide variation among hospitals.
Nearly 53 million prior authorization requests were submitted to Medicare Advantage insurers on behalf of Medicare Advantage enrollees in 2024, of which 4.1 million (7.7%) were denied. Just 11.5% of denied requests were appealed, though 80.7% of appeals overturned the initial denial in Medicare Advantage. Substantially fewer prior authorization requests were made in traditional Medicare, reflecting the small number of services subject to prior authorization requirements.
The Medicare Part D prescription drug benefit is provided by private plans, either Medicare Advantage plans that offer drug coverage (MA-PDs) or, for those in traditional Medicare, stand-alone prescription drug plans (PDPs). New data from CMS shows that 56 million people are enrolled in Part D plans as of February 2026, with more in MA-PDs than PDPs, reflecting higher overall enrollment in Medicare Advantage than in traditional Medicare. Enrollment in group MA-PD plans decreased while…
This analysis of trends in health insurers’ financial data shows that insurers’ gross margins per enrollee dipped slightly in 2024 across four markets, remaining highest in the Medicare Advantage market, followed by the individual (non-group) market, the fully insured group (employer) market, and Medicaid managed care. The analysis also examines insurers’ medical-loss ratios across the four markets.
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