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  • An Estimated 1 in 4 Medicare Beneficiaries With Obesity or Overweight Could Be Eligible for Medicare Coverage of Wegovy, an Anti-Obesity Drug, to Reduce Heart Risk

    News Release

    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…

  • Recent Trends in GLP-1 Use and Spending in Medicare

    Issue Brief

    Ahead of the Trump administration’s planned expansion of Medicare coverage for GLP-1s to treat obesity through temporary models and the availability of Medicare’s negotiated price for certain GLP-1 products beginning in 2027, this analysis examines CMS’s Medicare Part D claims data from 2019 to 2024 to document the increase in the number of beneficiaries being treated with GLP-1 drugs and the growth in Medicare spending and claims for these drugs.

  • Estimates of Medicare Beneficiaries’ Out-of-Pocket Drug Spending in 2006

    Report

    This report projects the impact of the new Medicare drug benefit on out-of-pocket spending for people who enroll in 2006. This analysis from November 2004 estimates that 6.9 million beneficiaries are projected to be affected by the coverage gap (the so-called "doughnut hole") in the standard Part D drug benefit. This estimate is based on projected enrollment in Part D plans of 29 million (Congressional Budget Office, July 2004), prior to implementation of the drug…

  • Medicare Advantage 2010 Data Spotlight: Benefits and Cost-Sharing

    Issue Brief

    This data spotlight examines trends in benefits and cost-sharing for Medicare Advantage plans in 2010, including the wide variations found across plans and the rapid increase in cost sharing requirements for some benefits, including stays in skilled nursing facilities. It also examines the annual limits on out-of-pocket spending set by most Medicare Advantage plans and the availability of coverage for drugs in the Medicare drug benefit's coverage gap, or "doughnut hole." This data spotlight is…

  • What Do People with Medicare Think About the Role of Marketing, Shopping for Medicare Options, and Their Coverage?

    Report

    To capture Medicare beneficiaries’ views and experiences in choosing between traditional Medicare and private plans, and among private plans, and the factors that influence these decisions, KFF worked with PerryUndem to conduct focus groups with Medicare beneficiaries in the Fall of 2022, during the annual Medicare open enrollment period. This report summarizes first-hand accounts of participants’ reactions open enrollment advertising and factors that influence their decision-making around Medicare plan choice.

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

    Issue Brief

    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 impact of different out-of-pocket spending caps in terms of how many beneficiaries would be affected and how much they…

  • Key Facts About Medicare Part D Enrollment and Costs in 2022

    Issue Brief

    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.

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

    Issue Brief

    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 of the drug price negotiation proposal in the BBBA. This analysis is designed to highlight the types of Medicare-covered drugs…

  • Medicare: An Overview

    Feature

    This slideshow explains key elements of the Medicare program, which now provides health coverage to 55 million people — including 46 million people age 65 and older and another 9 million younger adults with permanent disabilities.