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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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  • A Status Report on Prescription Drug Policies and Proposals at the Start of the Biden Administration

    Issue Brief

    This brief provides a status update on prescription drug final rules advanced by the Trump Administration in its final months related to Medicare, importation, and 340B pricing for insulin and epinephrine, and an overview of key drug pricing proposals related to Medicare and prescription drug prices generally that were voted on but not enacted in the previous Congress that may return to the forefront of health policy discussions in the coming years.

  • Is the End of the Long-Term Care Crisis Within Sight? New COVID-19 Cases and Deaths in Long-Term Care Facilities Are Dropping

    Policy Watch

    This analysis compares trends in new COVID-19 cases and deaths among nursing facility residents with trends in all other new COVID-19 cases and deaths excluding nursing facility residents through February 7, 2021. This analysis shows a marked divergence in new cases and deaths per week between nursing facility residents and the rest of the US population since December 2020. This drop in new deaths and cases in nursing facility residents coincides with the start of…

  • March 30 Web Event: Unsung Heroes: The Crucial Role – and Tenuous Circumstances – of Home Care Workers During the Pandemic

    Event Date:
    Event

    Even as the pandemic took a devastating toll on health care workers and older adults in the United States, many home care workers continued to report to work and provide vital care to vulnerable people despite the health risks to themselves and their own families. KFF’s Kaiser Health News and The John A. Hartford Foundation held an interactive web event on March 30 to examine the crucial roles home care workers have played for families during…

  • January 14 Web Event: A Shot in the Arm For Long-Term Care Facilities? Early Lessons from the COVID-19 Vaccine Rollout to High Priority Populations

    Event Date:
    Event

    With the pandemic taking a heavy toll among older Americans, the Centers for Disease Control and Prevention and most states have placed a high priority on vaccinating residents and staff of long-term care facilities. People in nursing homes and other long-term care settings account for 6 percent of cases but 38 percent of deaths from COVID-19, a share that has remained largely consistent throughout the pandemic, according to KFF’s updated analysis. KFF held an interactive…

  • Does Education Narrow the Gap in Wealth Among Older Adults, by Race and Ethnicity?

    Issue Brief

    This analysis of per capita income and assets among older adults in 2019 shows that differences in median per capita income among White, Black, and Hispanic adults ages 65 and older are narrower when comparing people with similar levels of education, although among college graduates, the gap in income continues to be wide between Hispanic and White seniors. The gaps in savings and home equity remain wide, and are particularly striking among seniors with less…

  • Addressing the Risk of Medicare Trust Fund Insolvency

    Perspective

    In this Viewpoint for the Journal of the American Medical Association (JAMA), KFF's Tricia Neuman and co-author Richard G. Frank of Harvard Medical School explain that the looming 2024 insolvency of the Medicare Hospital Insurance Trust Fund cannot be ignored for long.

  • Higher and Faster Growing Spending Per Medicare Advantage Enrollee Adds to Medicare’s Solvency and Affordability Challenges

    Issue Brief

    This analysis finds that Medicare spending for Medicare Advantage enrollees was $321 higher per person in 2019 than if enrollees had instead been coverage by traditional Medicare, leading to an estimated $7 billion in additional spending in 2019. It also examines the implications of expected growth in Medicare Advantage enrollment and payments per enrollee from 2021 to 2029.

  • Payments to Medicare Advantage Plans Boosted Medicare Spending by $7 Billion in 2019

    News Release

    The federal government spent $321 more per person for beneficiaries enrolled in Medicare Advantage plans than for those in traditional Medicare in 2019, a gap that amounted to $7 billion in additional spending on the increasingly popular private plans that year, finds a new KFF analysis. The Medicare Advantage spending includes the cost of extra benefits, such as vision, dental and hearing coverage that are funded by rebates and not covered for beneficiaries in traditional…