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How Medicare Advantage Rebates Disadvantage Medicare’s Stand-Alone Drug Plan Market

Rebates that reduce Part D premiums for Medicare Advantage plans with drug coverage make it harder for stand-alone prescription drug plans (PDPs) to compete. That may contribute to instability in the PDP market relied on by people in traditional Medicare. The number of Part D stand-alone Rx drug plan options for the avg Medicare beneficiary has fallen by half in recent years, while Medicare Advantage drug plan options have risen.

Also: Medicare Part D Enrollment, Premiums, and Cost Sharing in 2026

Analyzing Changes in Medicare Part D Enrollment for 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

NEW AND 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 in 2026: Enrollment Update and Key Trends

More than half (55%) of eligible Medicare beneficiaries are enrolled in Medicare Advantage in 2026, continuing a decades-long shift toward private plans. Special Needs Plans have driven recent growth, with nearly 1 in 4 enrollees now in such plans.
To better understand trends in the growth of the Medicare Advantage program, this brief provides current information about enrollment, including by plan type and firm.

See Also: Medicare Advantage in 2026: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization

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

Medicare Advantage Out-of-Pocket Limits: Variation & Trends

Prescription Drugs

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

CMS's temporary program to cover GLP-1 drugs for obesity in Medicare, called the BALANCE model, will not launch as scheduled on January 1, 2027. Instead, CMS is extending the Medicare GLP-1 Bridge, a separate short-term program that was to run from July to December 2026. It will now run through the end of 2027.

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

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. u003cbru003eu003cbru003eExplore 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.u003cbru003eu003cbru003eu003ca href=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022 data-type=u0022linku0022 data-id=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022u003eRelated:u003ca href=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022u003e FAQs on Medicare Financing and Trust Fund Solvencyu003c/au003eu003c/au003e

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  • Health News Index March/April, 2001

    Poll Finding

    Health News Index March/April, 2001   The March/April, 2001 edition of the Kaiser Family Foundation/HarvardSchool of Public Health Health News Index includes questions about major health stories covered in the news, including questions about the financial future of Social Security and Medicare. The Health News Index is designed to help the news media and people in the health field gain a better understanding of which health stories Americans are following and what they understand about…

  • Medicaid’s Disabled Population and Managed Care

    Fact Sheet

    Medicaid's Disabled Population and Managed Care This fact sheet highlights the key facts about the Medicaid managed care programs that serve persons with disabilities. It describes the Medicaid disabled population and the role managed care plays in serving them. It also provides information on enrollment in managed care, program features, and issues such as quality assurance, rate setting, and benefits. Fact Sheet

  • Prescription Drug Coverage for the Medicare Population

    Report

    Diane Rowland, executive director of the Commission, testified to the Subcommittee on Health of the U.S. House Committee on Energy and Commerce about providing prescription drugs to seniors. Her testimony includes discussion of Medicaid's role in providing outpatient drug coverage. Testimony Chart Pack

  • Pulling it Together: Last Week’s Health Reform “Shocker”

    Perspective

    Last week we learned that health reform could cost the federal government at least a trillion dollars over ten years, and that it will be really difficult to forge bipartisan agreement on legislation and keep major interest groups on board. This obviously brought more angst to the deliberations, several Republicans seized the moment to criticize the Democrats' plans, and the press was all over it, with many commentators declaring health reform in dire straits. But…

  • Kaiser Health Tracking Poll — December 2009

    Poll Finding

    The December Kaiser Health Tracking Poll finds a dip on several measures of public opinion on health care reform. The number of Americans who say they personally will be better off if reform passes fell to 35 percent in December, down from 42 percent last month. Meanwhile, 27 percent say they will be worse off, and 32 percent said they don’t expect to see much of a difference. Similarly, 45 percent say the country would…

  • Medicare Advantage 2010 Data Spotlight: Plan Enrollment Patterns and Trends

    Issue Brief

    This data spotlight examines at enrollment trends in Medicare Advantage plans, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs) and Private Fee-for-Service (PFFS) plans. These plans are paid by the government to provide Medicare-covered benefits to those who choose to enroll in them. As of March 2010, a record 11.1 million people – nearly one in four of all Medicare beneficiaries – were enrolled in private Medicare Advantage plans, up from 10.5 million in…

  • Displaced by Hurricane Katrina: Issues and Options for Medicare Beneficiaries

    Issue Brief

    An estimated 200,000 Medicare beneficiaries were displaced by Hurricane Katrina. Medicare played a key role in meeting the health care needs of the elderly and disabled beneficiaries who were displaced by the hurricane. Many of these beneficiaries face new challenges as a direct result of the hurricane. This issue brief identifies issues and challenges for individuals on Medicare affected by the hurricane and offers options for addressing these problems during the transition period. This issue…

  • Toplines: December 2005 Kaiser Health Poll Report

    Poll Finding

    Toplines: December 2005 Kaiser Health Poll Report These toplines provide the complete survey questions and responses to the December 2005 Kaiser Health Poll Report Survey, a bimonthly survey designed to provide key tracking information on public opinion about health care topics. The survey includes a series of questions on seniors' views of the new Medicare prescription drug benefit. Survey Toplines (.pdf)

  • The Stability of Medicaid Coverage for Low-Income Dually Eligible Medicare Beneficiaries

    Report

    This report examines the stability of dual eligibility for the seven million Americans who rely on Medicaid to fill the gaps in their Medicare coverage and its implications for Medicare's new prescription drug benefits. The analysis focuses on the duration of dual eligibility, the rates of gain and loss of Medicaid coverage and sources of Medicare supplementation preceding and following periods of Medicaid enrollment. The paper analyzes data from the Medicare Current Beneficiaries Surveys from…

  • Toward Making Medicare Work for Low-Income Beneficiaries: A Baseline Comparison of the Part D Low-Income Subsidy and Medicare Savings Programs Eligibility and Enrollment Rules

    Report

    Toward Making Medicare Work for Low-Income Beneficiaries: A Baseline Comparison of the Part D Low-Income Subsidy and Medicare Savings Programs Eligibility and Enrollment Rules This report examines how the low-income provisions of the Medicare drug benefit interact with state-level assistance provided through the Medicare Savings Program. The Medicare drug benefit provides additional help with premiums and cost-sharing requirements for eligible, low-income beneficiaries. The Social Security Administration oversees enrollment in this program. Separately, each state runs…