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What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid

The BALANCE Model expands coverage of GLP-1s for obesity in Medicaid beginning in 2026 and under Medicare beginning in 2027. This brief describes current coverage of GLP-1s in the programs, CMS's efforts to expand access to and lower costs for GLP-1s, and potential impacts on beneficiaries and program budgets.

Key Facts About Medicare Drug Price Negotiation

Recent Trends in GLP-1 Use and Spending in Medicare

What to Know About Pharmacy Benefit Managers (PBMs) and Federal Efforts at Regulation

The IRA Has Improved Coverage of Drugs Selected for Medicare Price Negotiation

New & Noteworthy

What to Know About Medicare Coverage of Telehealth

Congress has repeatedly extended pandemic-era flexibilities around Medicare coverage of telehealth, but most such flexibilities remain temporary. This brief answers key questions about the current scope of Medicare telehealth coverage, including both temporary and permanent changes adopted through legislation and regulation, and future policy considerations.

Examining the Potential Impact of Medicare’s New WISeR Model

A federal initiative to establish new prior authorization requirements in traditional Medicare, called the Wasteful and Inappropriate Service Reduction (WISeR) model, is likely to have only modest impact in its first year.

State Profiles for Dual-Eligible Individuals

This data collection draws on Medicare and Medicaid administrative data to present national and state-level information on people who are covered by both Medicare and Medicaid, referred to as dual-eligible individuals (also known as dually-enrolled beneficiaries).

Medicare Advantage

Medicare Advantage Enrollment Grew by About 1 Million People, Mainly Due to Special Needs Plans

Medicare Advantage enrollment rose to 35.1 million people as of Feb. 1, an increase of 1.1 million since February 2025. The 3% uptick belied Medicare Advantage insurers’ projections that overall enrollment would decline compared to 2025. It was the lowest annual percentage increase in two decades.
The latest increase was largely driven by rising enrollment in Medicare Advantage Special Needs Plans (SNPs), which accounted for 83% of enrollment gains in 2026. However, three of the five largest Medicare Advantage insurers, including market leader UnitedHealth Group, Inc., experienced overall Medicare Advantage enrollment declines.

How Medicare Pays Medicare Advantage Plans: Issues and Policy Options

Medicare Advantage Enrollees Have Access to About Half of the Physicians Available to Traditional Medicare Beneficiaries

Medicare Advantage Insurers Made Nearly 53 Million Prior Authorization Determinations in 2024

Most Medicare Beneficiaries Affected by Plan Terminations in 2025 Have Robust Medicare Advantage Options in 2026

Medicare Part D

Analyzing Changes in Medicare Part D Enrollment for 2026

Analysis of CMS data shows that 56.1 million people have Medicare Part D drug coverage as of Feb. 2026, with 56% of enrollees in Medicare Advantage plans with drug coverage (MA-PDs) and 44% in stand-alone prescription drug plans (PDPs.)PDP enrollment increased, mainly due to the rise in enrollment in group employer/union plans for retirees.

Between 2025 and 2026, enrollment in group Medicare Advantage drug plans dropped for the first time since 2010, while group PDP enrollment rose by the largest amount Since 2013.

Premiums Are Decreasing for Many Stand-Alone Part D Drug Plans in a Number of States in 2026

Stand-Alone Drug Plans Cover a Larger Share of Part D Enrollees Living in the Most Rural Areas Than Medicare Advantage Plans

A Current Snapshot of the Medicare Part D Prescription Drug Benefit

Changes to Medicare Part D in 2024 and 2025 Under the Inflation Reduction Act and How Enrollees Will Benefit

Data Visualization

The Facts About Medicare Spending

This interactive provides the facts on Medicare spending. Medicare, which serves 67 million people and accounts for 12 percent of the federal budget and 21 percent of national health spending, is often the focus of discussions about health expenditures, health care affordability and the sustainability of federal health programs.

Explore data on enrollment growth, Medicare spending trends overall and per person, growth in Medicare spending relative to private insurance, spending on benefits and Medicare Advantage, Part A trust fund solvency challenges, and growth in out-of-pocket spending by beneficiaries.

Related: FAQs on Medicare Financing and Trust Fund Solvency

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Medicare Open Enrollment

Beneficiaries Have 32 Medicare Advantage Prescription Drug Plans Available, on Average, for 2026

The average Medicare beneficiary will be able to choose among 32 Medicare Advantage plans with prescription drug coverage for 2026, two fewer than in 2025. The number of MA-PD options has grown steadily since 2010, peaking in 2024 when the average Medicare beneficiary had 36 options. Open enrollment runs October 15 through December 7.

Also: Medicare Open Enrollment FAQs

Premiums Are Decreasing for Many Stand-Alone Drug Plans in a Number of States in 2026

A Current Snapshot of the Medicare Part D Prescription Drug Benefit

The Role of SHIPs in Helping People with Medicare Navigate Their Coverage

What to Know About the Medicare Open Enrollment Period and Medicare Coverage Options

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  • The Role of Medicare and the Indian Health Service for American Indians and Alaska Natives: Health, Access and Coverage

    Report

    This report examines the role of both Medicare and the Indian Health Service (IHS) in providing access to health care for about 650,000 American Indians and Alaska Natives who are age 65 and older or who have permanent disabilities. While Medicare provides important health care coverage for most in this group, its relatively high cost-sharing and gaps in benefits can be problematic for American Indians and Alaska Native Medicare beneficiaries who do not have additional supplemental coverage or who cannot access IHS providers.

  • Visualizing Health Policy: Medicare Spending: A Look at Present, Short-Term and Long-Term Trends

    Other Post

    This Visualizing Health Policy infographic with the Journal of the American Medical Association (JAMA) provides an overview of Medicare spending trends in the present, short term and long term. In the long term, Medicare spending as a share of the economy is projected to grow, and Medicare is projected to lack sufficient funds to pay all hospital bills beginning in 2030.

  • The Latest on Geographic Variation in Medicare Spending: A Demographic Divide Persists But Variation Has Narrowed

    Report

    This report uses the most current data available to analyze Medicare per beneficiary spending, by county, in 2013; the growth in Medicare per beneficiary spending between 2007 and 2013, by county; and the extent to which geographic variation in Medicare per beneficiary spending has increased or decreased over time. The analysis finds that beneficiaries living in counties with relatively high Medicare per beneficiary spending tend to be sicker and poorer than beneficiaries living in lower-spending counties and that the gap between high and low-spending counties narrows but does not close after adjustments are made for differences in prices and beneficiaries’ health status. The analysis also shows that the amount of variation between the highest- and lowest-spending counties appears to have narrowed in recent years, raising questions as to whether these changes are due to specific shifts in payment policy. An interactive U.S. map showing county-level Medicare spending is also available.

  • How Would a Long-Term “Doc Fix” Affect Seniors’ Medicare Costs?

    News Release

    In this new Policy Insight, the Kaiser Family Foundation’s Cristina Boccuti and Tricia Neuman examine how Congress’ effort to permanently stave off scheduled cuts in Medicare’s physician payments could affect what Medicare beneficiaries pay for their care -- both in premiums and in other potential changes -- to offset the cost of the Sustainable Growth…

  • Comparison of Consumer Protections in Three Health Insurance Markets: Medicare Advantage, Qualified Health Plans and Medicaid Managed Care Organizations

    Report

    This report examines similarities and differences in federal consumer protection standards for Medicare Advantage (MA) plans, Qualified Health Plans (QHPs), and Medicaid Managed Care Organizations (MCOs). It focuses on rules established at the federal level, though some states have chosen to go above the federal minimums and impose additional requirements for QHPs and Medicaid MCOs.

  • Medicare 101: What You Need To Know

    Event Date:
    Event

    Hosted by the Kaiser Family Foundation and the Alliance for Health Reform, this briefing reviewed basic questions about the Medicare program, such as: What services does Medicare provide, and how does Medicare pay for these services? How is Medicare financed? What changes did the Affordable Care Act (ACA) make to Medicare? How fast is Medicare spending growing? What are current proposals to strengthen Medicare for the future, and what are prospects for action in the new Congress?

  • How Much (More) Will Seniors Pay for a Doc Fix?

    Perspective

    In this Policy Insight, the Foundation’s Cristina Boccuti and Tricia Neuman examine how Congress’ effort to permanently stave off scheduled cuts in Medicare’s physician payments could affect what Medicare beneficiaries pay for their care -- both in premiums and in other potential changes -- to offset the cost of the Sustainable Growth Rate (SGR) “doc fix.”